| Entity Name: | DIXIE HIGHWAY SNF LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 22 Oct 2012 (12 years ago) |
| Date of dissolution: | 28 Jun 2020 (5 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 28 Jun 2020 (5 years ago) |
| Document Number: | L12000134255 |
| FEI/EIN Number | 46-1236674 |
| Address: | 400 Rella Blvd, #200, Montebello, NY, 10901, US |
| Mail Address: | 400 Rella Blvd, #200, Montebello, NY, 10901, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073866166 | 2012-10-26 | 2012-12-06 | 1835 NE MIAMI GARDENS DR # 368, NORTH MIAMI BEACH, FL, 331795035, US | 715 E DIXIE AVE, LEESBURG, FL, 347485926, US | |||||||||||||||||||||
|
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| Phone | +1 352-728-3020 |
| Fax | 3527286071 |
Authorized person
| Name | MR. TZVI BOGOMILSKY |
| Role | AUTHORIZED MEMBER |
| Phone | 3054031400 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025295600 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| BOGOMILSKY TZVI | Managing Member | 400 Rella Blvd, Montebello, NY, 10901 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000110118 | SOUTH CAMPUS REHABILITATION AND NURSING CENTER | EXPIRED | 2012-11-14 | 2017-12-31 | No data | 1835 NE MIAMI GARDENS DRIVE #368, NORTH MIAMI BEACH, FL, 33179 |
| G12000103186 | LEESBURG HEALTH AND REHABILITATION CENTER | EXPIRED | 2012-10-23 | 2017-12-31 | No data | 1835 NE MIAMI GARDENS DRIVE #368, NORTH MIAMI BEACH, FL, 33179 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2020-06-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-11 | 400 Rella Blvd, #200, Montebello, NY 10901 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-11 | 400 Rella Blvd, #200, Montebello, NY 10901 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2020-06-28 |
| ANNUAL REPORT | 2019-04-10 |
| ANNUAL REPORT | 2018-04-11 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-03-22 |
| ANNUAL REPORT | 2015-04-17 |
| ANNUAL REPORT | 2014-03-19 |
| ANNUAL REPORT | 2013-01-28 |
| Florida Limited Liability | 2012-10-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
