| Entity Name: | LAKE CITY NURSING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 May 2021 (4 years ago) |
| Document Number: | L21000209963 |
| FEI/EIN Number | 871088123 |
| Mail Address: | 3599 W LAKE MARY BLVD, LAKE MARY, FL, 32746, US |
| Address: | 3599 W. LAKE MARY BLVD., LAKE MARY, FL, 32746, US |
| ZIP code: | 32746 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194392936 | 2021-06-09 | 2021-06-09 | 3599 W LAKE MARY BLVD STE 1F, LAKE MARY, FL, 327463417, US | 1270 SW MAIN BLVD, LAKE CITY, FL, 320256684, US | |||||||||||||||||||||||||
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| Phone | +1 352-874-6007 |
| Fax | 3524044078 |
| Phone | +1 386-752-7900 |
| Fax | 3867586169 |
Authorized person
| Name | VICTORIA SHARPLESS |
| Role | DIRECTOR OF ACCOUNTING |
| Phone | 3528746007 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 261629-00 |
| State | FL |
| Name | Role |
|---|---|
| PARACORP INCORPORATED | Agent |
| Name | Role | Address |
|---|---|---|
| SWAIN STEWART JR. | Manager | 980 KAY GIBBONS CT., KERNERSVILE, NC, 27284 |
| EDMANDS ANTHONY | Manager | 3599 W. LAKE MARY BLVD, STE 1-F, LAKE MARY, FL, 32746 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000076635 | THE PALMS NURSING AND REHAB AT LAKE CITY | ACTIVE | 2021-06-08 | 2026-12-31 | No data | 1270 SW MAIN BLVD., LAKE CITY, FL, 32025 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-08-13 | 3599 W. LAKE MARY BLVD., SUITE 1F, LAKE MARY, FL 32746 | No data |
| CHANGE OF MAILING ADDRESS | 2021-08-13 | 3599 W. LAKE MARY BLVD., SUITE 1F, LAKE MARY, FL 32746 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-19 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-04-13 |
| Florida Limited Liability | 2021-05-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
