| Entity Name: | TERRACE OF JACKSONVILLE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 26 Mar 2014 (11 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 23 Apr 2021 (4 years ago) |
| Document Number: | L14000050232 |
| FEI/EIN Number | 46-5214725 |
| Address: | 10680 OLD ST AUGUSTINE RD, JACKSONVILLE, FL 32257 |
| Mail Address: | 10680 OLD ST AUGUSTINE RD, JACKSONVILLE, FL 32257 |
| ZIP code: | 32257 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710305586 | 2014-03-31 | 2014-10-27 | 10680 OLD SAINT AUGUSTINE RD, JACKSONVILLE, FL, 322571000, US | 10680 OLD SAINT AUGUSTINE RD, JACKSONVILLE, FL, 322571000, US | |||||||||||||||||||||||||
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| Phone | +1 904-268-4953 |
| Fax | 9042683431 |
Authorized person
| Name | MISTY DEGROSS |
| Role | ADMINISTRATOR |
| Phone | 9042684953 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF13060961 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 031237100 |
| State | FL |
| Name | Role |
|---|---|
| INCORP SERVICES, INC. | Agent |
| Name | Role |
|---|---|
| JV LTC HOLDINGS LLC | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000054470 | THE TERRACE OF JACKSONVILLE | ACTIVE | 2022-04-29 | 2027-12-31 | No data | 10680 OLD ST AUGUSTINE RD, JACKSONVILLE, FL, 32257 |
| G14000032480 | THE TERRACE OF JACKSONVILLE | EXPIRED | 2014-04-01 | 2019-12-31 | No data | 12221 WEST DIXIE HWY, NORTH MIAMI, FL, 33161 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-17 | 3458 LAKESHORE DRIVE, TALLAHASSEE, FL 32312 | No data |
| LC AMENDMENT | 2021-04-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-03 | 10680 OLD ST AUGUSTINE RD, JACKSONVILLE, FL 32257 | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-03 | 10680 OLD ST AUGUSTINE RD, JACKSONVILLE, FL 32257 | No data |
| REGISTERED AGENT NAME CHANGED | 2015-04-03 | INCORP SERVICES, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-04-27 |
| LC Amendment | 2021-04-23 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-03-18 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-03-31 |
| ANNUAL REPORT | 2016-04-15 |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 341711471 | 0419700 | 2016-08-18 | 10680 OLD ST. AUGUSTINE RD., JACKSONVILLE, FL, 32257 | |||||||||||||||||||
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| Type | Complaint |
| Activity Nr | 1124591 |
| Health | Yes |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 9533067201 | 2020-04-28 | 0491 | PPP | 10680 OLD SAINT AUGUSTINE RD, JACKSONVILLE, FL, 32257-1000 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 21 Feb 2025
Sources: Florida Department of State
