| Entity Name: | 699 ASSISTED LIVING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
699 ASSISTED LIVING, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 28 Jul 2021 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 15 Feb 2022 (3 years ago) |
| Document Number: | L21000341728 |
| FEI/EIN Number |
87-1978836
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 699 N. DIXIE FREEWAY, NEW SMYRNA BEACH, FL, 32168, US |
| Mail Address: | 20 Mount View, Colorado Springs, CO, 80907, US |
| ZIP code: | 32168 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124741418 | 2022-09-21 | 2024-02-23 | 20 MOUNT VIEW LN STE C, COLORADO SPRINGS, CO, 809074359, US | 699 N DIXIE FWY, NEW SMYRNA BEACH, FL, 321686415, US | |||||||||||||||||||||
|
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| Phone | +1 949-338-4851 |
| Phone | +1 386-272-3042 |
Authorized person
| Name | ROBYN BRACKETT |
| Role | OPERATIONS DIRECTOR |
| Phone | 9493384851 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 119739700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| IAN KALLENBACH | Manager | 699 N. DIXIE FREEWAY, NEW SMYRNA BEACH, FL, 32168 |
| Petra Matthew | Agent | 315 East Robinson Street, Orlando, FL, 32801 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000012565 | SEASHORE SENIOR LIVING | ACTIVE | 2022-01-31 | 2027-12-31 | - | 8111 VALLI-FARM RD, FOUNTAIN, CO, 80817 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-01-26 | 699 N. DIXIE FREEWAY, NEW SMYRNA BEACH, FL 32168 | - |
| REGISTERED AGENT NAME CHANGED | 2023-01-26 | Petra, Matthew | - |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-26 | 315 East Robinson Street, Ste 600, Orlando, FL 32801 | - |
| LC AMENDMENT | 2022-02-15 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-26 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-04-11 |
| LC Amendment | 2022-02-15 |
| Florida Limited Liability | 2021-07-28 |
Date of last update: 03 Mar 2025
Sources: Florida Department of State
