| Entity Name: | BELLA VIDA AT LAKE FOREST, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Aug 2022 (2 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 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871212357 | 2022-08-26 | 2022-08-26 | 7901 4TH ST N STE 300, ST PETERSBURG, FL, 337024399, US | 4055 LAKE FOREST ST, MOUNT DORA, FL, 327575211, US | |||||||||||||||
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| Phone | +1 352-269-3779 |
| Fax | 3212565193 |
Authorized person
| Name | PENNY BROWNELL |
| Role | ADMINISTRATOR |
| Phone | 3524315159 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Gist Keisha L | Agent | 40105 French Rd, Lady Lake, FL, 32159 |
| 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 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-30 | 4055 LAKE FOREST ST, MOUNT DORA, FL 32757 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-04-30 | Gist, Keisha L | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-30 | 40105 French Rd, Lady Lake, FL 32159 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-02-21 |
| Florida Limited Liability | 2022-08-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
