| Entity Name: | FUTURE SMILES SENIOR LIVING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 29 Nov 2021 (3 years ago) |
| Document Number: | L21000505572 |
| FEI/EIN Number | 87-3740013 |
| Address: | 4645 SW VAHALLA STREET, PORT SAINT LUCIE, FL 34953 |
| Mail Address: | 4645 SW VAHALLA STREET, PORT SAINT LUCIE, FL 34953 |
| ZIP code: | 34953 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730847955 | 2021-12-05 | 2023-03-28 | 4645 SW VAHALLA STREET, PORT SAINT LUCIE, FL, 34953, US | 4645 SW VAHALLA STREET, PORT SAINT LUCIE, FL, 34953, US | |||||||||||||||||||
|
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| Phone | +1 772-878-5547 |
Authorized person
| Name | MR. FERNANDO J BRAS |
| Role | PRESIDENT/CEO |
| Phone | 7723006670 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 115155700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRAS, FERNANDO J | Agent | 4645 SW VAHALLA STREET, PORT SAINT LUCIE, FL 34953 |
| Name | Role | Address |
|---|---|---|
| BRAS, FERNANDO J | PRESIDENT | 2948 SW WESTLAKE CIRCLE, PALM CITY, FL 34990 |
| Name | Role | Address |
|---|---|---|
| BRAS, FERNANDO J | Chief Executive Officer | 2948 SW WESTLAKE CIRCLE, PALM CITY, FL 34990 |
| Name | Role | Address |
|---|---|---|
| SANTIAGO, MICHELLE M | ADMINISTRATOR | 1514 SW LEISURE LANE, PORT SAINT LUCIE, FL 34953 |
| Name | Role | Address |
|---|---|---|
| SANTIAGO, MICHELLE M | Chief Operating Officer | 1514 SW LEISURE LANE, PORT SAINT LUCIE, FL 34953 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-04-04 | 4645 SW VAHALLA STREET, PORT SAINT LUCIE, FL 34953 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-04 | 4645 SW VAHALLA STREET, PORT SAINT LUCIE, FL 34953 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-18 | 4645 SW VAHALLA STREET, PORT SAINT LUCIE, FL 34953 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-10 |
| ANNUAL REPORT | 2024-03-07 |
| ANNUAL REPORT | 2023-04-04 |
| Florida Limited Liability | 2021-11-29 |
Date of last update: 12 Feb 2025
Sources: Florida Department of State
