| Entity Name: | 5901 NW 79TH AVENUE OPERATIONS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 May 2018 (7 years ago) |
| Last Event: | LC STMNT CORR |
| Event Date Filed: | 17 Aug 2018 (6 years ago) |
| Document Number: | L18000124573 |
| FEI/EIN Number | 83-0789961 |
| Mail Address: | 5901 NW 79TH AVE, TAMARAC, FL, 33321-4639, US |
| Address: | 5901 NW 79TH AVENUE, TAMARAC, FL, 33321, US |
| ZIP code: | 33321 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366936197 | 2018-06-15 | 2024-09-13 | 5901 NW 79TH AVE, TAMARAC, FL, 333214639, US | 5901 NW 79TH AVE, TAMARAC, FL, 33321, US | |||||||||||||||||||||||
|
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| Phone | +1 954-722-7001 |
| Fax | 9547205419 |
| Phone | +1 407-571-1550 |
Authorized person
| Name | MIRIAM C. PASTOR |
| Role | MANAGER |
| Phone | 8137696280 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100298200 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| PASTOR MIRIAM | Manager | 5901 NW 79TH AVE, TAMARAC, FL, 333214639 |
| Name | Role |
|---|---|
| MLNM MASTER TENANT, LLC | Authorized Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000073279 | NSPIRE HEALTHCARE TAMARAC | ACTIVE | 2018-07-02 | 2028-12-31 | No data | 5901 NW 79TH AVE, TAMARAC, FL, 33321 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-04-29 | 5901 NW 79TH AVENUE, TAMARAC, FL 33321 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-24 | 5901 NW 79TH AVENUE, TAMARAC, FL 33321 | No data |
| LC STMNT CORR | 2018-08-17 | No data | STATEMENT OF CORRECTION FILED TO CH ANGE EFFECTIVE DATE FROM 5/17/18 TO 5/24/18 |
| LC AMENDMENT | 2018-06-28 | No data | No data |
| LC AMENDMENT | 2018-05-24 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-05-24 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-05-24 | 1201 HAYS STREET, Tallahassee, FL 32301 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-21 |
| ANNUAL REPORT | 2020-04-20 |
| ANNUAL REPORT | 2019-04-24 |
| CORLCSTCOR | 2018-08-17 |
| LC Amendment | 2018-06-28 |
| LC Amendment | 2018-05-24 |
| Florida Limited Liability | 2018-05-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
