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BELLA VIDA AT LAKE FOREST, LLC - Florida Company Profile

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Company Details

Entity Name: BELLA VIDA AT LAKE FOREST, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 19 Aug 2022 (3 years ago)
Document Number: L22000366687
FEI/EIN Number 88-3862649
Mail Address: 40105 French Rd, Lady Lake, FL, 32159, US
Address: 4055 LAKE FOREST ST, MOUNT DORA, FL, 32757
ZIP code: 32757
City: Mount Dora
County: Lake
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Gist Keisha L Auth 40105 French Rd, Lady Lake, FL, 32159
Gist Stanley X Auth 40105 French Rd, Lady Lake, FL, 32159
Gist Keisha L Agent 40105 French Rd, Lady Lake, FL, 32159

National Provider Identifier

NPI Number:
1871212357
Certification Date:
2022-08-26

Authorized Person:

Name:
PENNY BROWNELL
Role:
ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
310400000X - Assisted Living Facility
Is Primary:
Yes

Contacts:

Fax:
3212565193

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2024-04-30 4055 LAKE FOREST ST, MOUNT DORA, FL 32757 -
REGISTERED AGENT NAME CHANGED 2024-04-30 Gist, Keisha L -
REGISTERED AGENT ADDRESS CHANGED 2024-04-30 40105 French Rd, Lady Lake, FL 32159 -

Documents

Name Date
ANNUAL REPORT 2024-04-30
ANNUAL REPORT 2023-02-21
Florida Limited Liability 2022-08-19

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Date of last update: 03 Aug 2025

Sources: Florida Department of State