| Entity Name: | 4294 3RD AVENUE OPERATIONS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 Feb 2022 (3 years ago) |
| Document Number: | L22000075482 |
| FEI/EIN Number | 880846391 |
| Address: | 4294 3RD AVENUE, MARIANNA, FL, 32446, US |
| Mail Address: | 1810 Concord Lake Rd, Kannapolis, NC, 28083, US |
| ZIP code: | 32446 |
| County: | Jackson |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487301982 | 2022-03-04 | 2024-09-13 | 4294 3RD AVE, MARIANNA, FL, 324462137, US | 4294 3RD AVE, MARIANNA, FL, 324462137, US | |||||||||||||||||||||
|
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| Phone | +1 850-526-3191 |
| Fax | 8505264481 |
Authorized person
| Name | TIM LEHNER |
| Role | MANAGER |
| Phone | 7706989040 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000538300 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role |
|---|---|
| FMRGC HOLDCO, LLC | Member |
| Name | Role | Address |
|---|---|---|
| Walker Jeron | Manager | 1810 Concord Lake Rd, Kannapolis, NC, 28083 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000025118 | CHIPOLA HEALTH AND REHABILITATION CENTER | ACTIVE | 2022-03-02 | 2027-12-31 | No data | 1040 CROWN POINTE PARKWAY, SUITE 600, ATLANTA, GA, 30338 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-03-01 | 4294 3RD AVENUE, MARIANNA, FL 32446 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-24 | 4294 3RD AVENUE, MARIANNA, FL 32446 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-01 | 4294 3RD AVENUE, MARIANNA, FL 32446 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| ANNUAL REPORT | 2023-04-25 |
| Florida Limited Liability | 2022-02-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
