| Entity Name: | ATLANTIC CARE AND REHABILITATION CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 12 Aug 2015 (9 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | L15000138116 |
| FEI/EIN Number | 47-5314380 |
| Mail Address: | 505 MARLBORO ROAD, WOODRIDGE, NJ, 07075, US |
| Address: | 3663 15TH AVENUE, VERO BEACH, FL, 32960, US |
| ZIP code: | 32960 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851762876 | 2015-10-16 | 2016-07-08 | 3663 15TH AVE, VERO BEACH, FL, 329604868, US | 3663 15TH AVE, VERO BEACH, FL, 329604868, US | |||||||||||||||||||
|
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| Phone | +1 772-567-2552 |
Authorized person
| Name | PETER LEWIS |
| Role | AUTHORIZED REPRESENTATIVE |
| Phone | 8506687141 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 015959200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LEWIS PETER AJR. | Agent | 3023 N. SHANNON LAKES DRIVE, TALLAHASSEE, FL, 32309 |
| Name | Role |
|---|---|
| 15TH AVENUE HOLDINGS, LLC | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000093300 | ATLANTIC CARE AND REHABILITATION CENTER | EXPIRED | 2015-09-10 | 2020-12-31 | No data | 505 MARLBORO ROAD, WOODRIDGE, NJ, 07075 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| LC NAME CHANGE | 2015-10-27 | ATLANTIC CARE AND REHABILITATION CENTER LLC | No data |
| LC AMENDMENT | 2015-08-31 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J19000445773 | ACTIVE | 1000000831359 | COLUMBIA | 2019-06-24 | 2029-06-26 | $ 5,475.15 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1415 W US HIGHWAY 90 STE 115, LAKE CITY FL320556156 |
| J18000809897 | ACTIVE | 1000000806622 | COLUMBIA | 2018-12-10 | 2028-12-12 | $ 635.91 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1415 W US HIGHWAY 90 STE 115, LAKE CITY FL320556156 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-01-27 |
| ANNUAL REPORT | 2017-01-16 |
| ANNUAL REPORT | 2016-04-14 |
| LC Name Change | 2015-10-27 |
| LC Amendment | 2015-08-31 |
| Florida Limited Liability | 2015-08-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
