| Entity Name: | SHIFTING SANDS ADULT DAY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 06 Mar 2018 (7 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | L18000058878 |
| FEI/EIN Number | 82-4662042 |
| Address: | 28410 Bonita Crossings Blvd, Bonita Springs, FL, 34135, US |
| Mail Address: | 28410 Bonita Crossings Blvd, Bonita Springs, FL, 34135, US |
| ZIP code: | 34135 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841855822 | 2019-05-06 | 2019-06-11 | 28410 BONITA CROSSINGS BLVD UNIT 7, BONITA SPRINGS, FL, 341353211, US | 28410 BONITA CROSSINGS BLVD UNIT 7, BONITA SPRINGS, FL, 341353211, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 239-777-3422 |
| Phone | +1 239-405-7009 |
Authorized person
| Name | TAMMY WILKINSON |
| Role | ADMINISTRATOR |
| Phone | 2394057009 |
Taxonomy
| Taxonomy Code | 261QA0600X - Adult Day Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 101754500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RICHARDSON SCOTT | Agent | 1579 Whispering Oaks Circle, NAPLES, FL, 34110 |
| Name | Role | Address |
|---|---|---|
| RICHARDSON SCOTT | Authorized Representative | 1579 Whispering Oaks Circle, NAPLES, FL, 34110 |
| Name | Role | Address |
|---|---|---|
| WILKINSON TAMATHA | Manager | 1579 Whispering Oaks Circle, NAPLES, FL, 34110 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-05-29 | 28410 Bonita Crossings Blvd, Suite 7, Bonita Springs, FL 34135 | No data |
| CHANGE OF MAILING ADDRESS | 2019-05-29 | 28410 Bonita Crossings Blvd, Suite 7, Bonita Springs, FL 34135 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-05-29 | 1579 Whispering Oaks Circle, NAPLES, FL 34110 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-09-24 |
| ANNUAL REPORT | 2020-06-12 |
| ANNUAL REPORT | 2019-05-29 |
| Florida Limited Liability | 2018-03-06 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
