| Entity Name: | HERITAGE WATERSIDE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Jul 2015 (10 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 22 Jun 2022 (3 years ago) |
| Document Number: | L15000117784 |
| FEI/EIN Number | 81-5474046 |
| Address: | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL, 32168, US |
| Mail Address: | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL, 32168, US |
| ZIP code: | 32168 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114501574 | 2021-05-11 | 2021-05-11 | 3704 CARDINAL BLVD, DAYTONA BEACH SHORES, FL, 321187301, US | 3704 CARDINAL BLVD, DAYTONA BEACH SHORES, FL, 321187301, US | |||||||||||||||||||
|
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| Phone | +1 386-256-2015 |
Authorized person
| Name | MARK NAGRANI |
| Role | OWNER |
| Phone | 3862562015 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 109599800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NAGRANI MARK | Agent | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL, 32168 |
| Name | Role | Address |
|---|---|---|
| NAGRANI MARK | Manager | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL, 32168 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-01-18 | 2473 palmetto circle, South daytona, FL 32119 | No data |
| CHANGE OF MAILING ADDRESS | 2025-01-18 | 2473 palmetto circle, South daytona, FL 32119 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-18 | 2473 palmetto circle, South daytona, FL 32119 | No data |
| LC AMENDMENT | 2022-06-22 | No data | No data |
| LC NAME CHANGE | 2017-04-28 | HERITAGE WATERSIDE, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-18 |
| ANNUAL REPORT | 2024-03-14 |
| ANNUAL REPORT | 2023-02-28 |
| LC Amendment | 2022-06-22 |
| ANNUAL REPORT | 2022-04-05 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-06-06 |
| ANNUAL REPORT | 2019-02-17 |
| ANNUAL REPORT | 2018-02-11 |
| LC Name Change | 2017-04-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
