| Entity Name: | ORANGE PARK NURSING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 May 2021 (4 years ago) |
| Document Number: | L21000210200 |
| FEI/EIN Number | 871152454 |
| 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 | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720656390 | 2021-06-11 | 2021-06-11 | 3599 W LAKE MARY BLVD STE 1-F, LAKE MARY, FL, 327463417, US | 833 KINGSLEY AVE, ORANGE PARK, FL, 320734701, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 904-269-2610 |
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 | 130817-00 |
| State | FL |
| Name | Role |
|---|---|
| PARACORP INCORPORATED | Agent |
| Name | Role | Address |
|---|---|---|
| SWAIN STEWART JR. | Manager | 980 KAY GIBBONS CT., KERNERSVILLE, NC, 27284 |
| EDMANDS ANTHONY | Manager | 3599 W. LAKE MARY BLVD., SUITE 1F, LAKE MARY, FL, 32746 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000076648 | THE PALMS NURSING AND REHAB AT ORANGE PARK | ACTIVE | 2021-06-08 | 2026-12-31 | No data | 833 KINGSLEY AVE., ORANGE PARK, FL, 32073 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-03-19 | PARACORP INCORPORATED | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-19 | 155 OFFICE PLAZA DR, 1ST FL, TALLAHASSEE, FL 32301 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-08-13 | 3599 W. LAKE MARY BLVD., SUITE 1-F, LAKE MARY, FL 32746 | No data |
| CHANGE OF MAILING ADDRESS | 2021-08-13 | 3599 W. LAKE MARY BLVD., SUITE 1-F, LAKE MARY, FL 32746 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-19 |
| Reg. Agent Resignation | 2023-09-26 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-04-13 |
| Florida Limited Liability | 2021-05-05 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No data | IDV | 36C24821D0055 | 2021-04-10 | No data | No data | |||||||||||||||||||||||
|
||||||||||||||||||||||||||||
| Obligated Amount | 0.00 |
| Potential Award Amount | 20000000.00 |
Description
| Title | NURSING HOME SERVICES |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES |
Recipient Details
| Recipient | ORANGE PARK NURSING LLC |
| UEI | E425LUWT63M3 |
| Recipient Address | UNITED STATES, 3599 W LAKE MARY BLVD, STE 1F, LAKE MARY, SEMINOLE, FLORIDA, 327463417 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
