| Entity Name: | VILLAGE VERANDA AT LADY LAKE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 08 Feb 2017 (8 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 28 Sep 2022 (2 years ago) |
| Document Number: | L17000028597 |
| FEI/EIN Number | 81-5349408 |
| Address: | 11890 Windmill Lake Drive, Boynton Beach, FL 33473 |
| Mail Address: | 11890 Windmill Lake Drive, Boynton Beach, FL 33473 |
| ZIP code: | 33473 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780221077 | 2019-12-05 | 2020-02-26 | 2573 BARRINGTON CIR, TALLAHASSEE, FL, 323086805, US | 955 S US HIGHWAY 441, LADY LAKE, FL, 321595208, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 352-751-5494 |
Authorized person
| Name | SETH WALKER |
| Role | CFO |
| Phone | 8505837990 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AHCA ALF LICENSE |
| Number | 13312 |
| State | FL |
| Issuer | MEDICAID |
| Number | 104709300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Jackson Ogilvie , Nashika | Agent | 11890 Windmill Lake Drive, Boynton Beach, FL 33473 |
| Name | Role |
|---|---|
| VILLAGE VERANDA HOLDING COMPANY, LLC | Managing Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000042862 | VILLAGE VERANDA SENIOR LIVING COMMUNITY | ACTIVE | 2019-04-04 | 2029-12-31 | No data | 955 S. HIGHWAY 27/441, LADY LAKE, FL, 32159 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-26 | 11890 Windmill Lake Drive, Boynton Beach, FL 33473 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-26 | 11890 Windmill Lake Drive, Boynton Beach, FL 33473 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-03-26 | Jackson Ogilvie , Nashika | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-26 | 11890 Windmill Lake Drive, Boynton Beach, FL 33473 | No data |
| REINSTATEMENT | 2022-09-28 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-21 |
| ANNUAL REPORT | 2023-03-26 |
| REINSTATEMENT | 2022-09-28 |
| Reg. Agent Change | 2021-12-28 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-03-17 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-03-14 |
| Florida Limited Liability | 2017-02-08 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
