| Entity Name: | FOREST LANE HEALTHCARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 02 May 2024 (9 months ago) |
| Document Number: | L24000205914 |
| Address: | 1616 CONCIERGE BLVD, DAYTONA BEACH, FL 32117 |
| Mail Address: | 1616 CONCIERGE BLVD, DAYTONA BEACH, FL 32117 |
| ZIP code: | 32117 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447007638 | 2024-05-04 | 2024-05-04 | 818 FOREST LN, DAYTONA BEACH, FL, 321141916, US | 1616 CONCIERGE BLVD STE 103, DAYTONA BEACH, FL, 321177159, US | |||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-445-0261 |
| Phone | +1 386-271-2753 |
Authorized person
| Name | DAMOYA DAVIS |
| Role | CEO |
| Phone | 9044450261 |
Taxonomy
| Taxonomy Code | 163WH0200X - Home Health Registered Nurse |
| Is Primary | No |
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | Yes |
| Taxonomy Code | 251F00000X - Home Infusion Agency |
| Is Primary | No |
| Taxonomy Code | 251G00000X - Community Based Hospice Care Agency |
| Is Primary | No |
| Taxonomy Code | 251J00000X - Nursing Care Agency |
| Is Primary | No |
| Taxonomy Code | 332U00000X - Home Delivered Meals |
| Is Primary | No |
| Taxonomy Code | 343900000X - Non-emergency Medical Transport (VAN) |
| Is Primary | No |
| Taxonomy Code | 347C00000X - Private Vehicle |
| Is Primary | No |
| Taxonomy Code | 376K00000X - Nurse's Aide |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| DAVIS, DAMOYA | Agent | 1616 CONCIERGE BLVD OFFICE, 103, DAYTONA BEACH, FL 32117 |
| Name | Role | Address |
|---|---|---|
| DAVIS, DAMOYA | Manager | 1616 CONCIERGE BLVD, DAYTONA BEACH, FL 32117 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-05-02 |
Date of last update: 08 Feb 2025
Sources: Florida Department of State
