| Entity Name: | VILLA PALMS ASSISTED LIVING LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Dec 2020 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 02 Sep 2021 (3 years ago) |
| Document Number: | L20000389569 |
| FEI/EIN Number | 85-4373847 |
| Address: | 6722 WINKLER RD, FORT MYERS, FL 33919 |
| Mail Address: | 10275 NW 46th St, Sunrise, FL 33351 |
| ZIP code: | 33919 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780351718 | 2021-08-26 | 2021-08-26 | 6722 WINKLER RD, FORT MYERS, FL, 339197204, US | 6722 WINKLER RD, FORT MYERS, FL, 339197204, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 239-433-5553 |
| Fax | 2394819919 |
Authorized person
| Name | AJAY BAJAJ |
| Role | OWNER |
| Phone | 7322132883 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AHCA |
| Number | 7353 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Shrivastava, Abhishek | Agent | 10275 NW 46th St, Sunrise, FL 33351 |
| Name | Role | Address |
|---|---|---|
| SHRIVASTAVA, ABHISHEK | Authorized Manager | 10275 NW 46th St, Sunrise, FL 33351 |
| BAJAJ, AJAY | Authorized Manager | 4 REID AVE, BELLE MEAD, NJ 08502 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000152809 | VILLA PALMS | ACTIVE | 2021-11-15 | 2026-12-31 | No data | 6722 WINKLER RD, FORT MYERS, FL, 33191 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-05-01 | Shrivastava, Abhishek | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-05 | 6722 WINKLER RD, FORT MYERS, FL 33919 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-05 | 10275 NW 46th St, Sunrise, FL 33351 | No data |
| LC AMENDMENT | 2021-09-02 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-04-05 |
| LC Amendment | 2021-09-02 |
| Florida Limited Liability | 2020-12-14 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
