| Entity Name: | LADY LAKE NH, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Jul 2000 (25 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 07 Jul 2003 (22 years ago) |
| Document Number: | M00000001352 |
| FEI/EIN Number | 134118702 |
| Address: | 630 GRIFFIN AVE., LADY LAKE, FL, 32159-8101, US |
| Mail Address: | 630 Griffin Avenue, Lady Lake, FL, 32159, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326043050 | 2005-06-17 | 2021-06-27 | 630 GRIFFIN AVE, LADY LAKE, FL, 321598101, US | 630 GRIFFIN AVE, LADY LAKE, FL, 321598101, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 352-750-6619 |
| Fax | 3527500373 |
Authorized person
| Name | MOSHE SCHEINER |
| Role | CEO |
| Phone | 8135576200 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF130470994 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME) |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0227561-00 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Greystone Tribeca Acquisition II LLC | Auth | 630 Griffin Ave, Lady Lake, FL, 32159 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G00327900251 | LADY LAKE SPECIALTY CARE CENTER | ACTIVE | 2000-11-22 | 2025-12-31 | No data | C/O GREYSTONE HEALTHCARE MGMT CORP., 630 GRIFFIN AVE, LADY LAKE, FL, 32159-8101 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-03-05 | 630 GRIFFIN AVE., LADY LAKE, FL 32159-8101 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-09-09 | 630 GRIFFIN AVE., LADY LAKE, FL 32159-8101 | No data |
| REGISTERED AGENT NAME CHANGED | 2004-10-04 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-10-04 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| AMENDMENT | 2003-07-07 | No data | No data |
| AMENDMENT | 2003-05-30 | No data | No data |
| NAME CHANGE AMENDMENT | 2000-11-16 | LADY LAKE NH, L.L.C. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-05 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-01-25 |
| ANNUAL REPORT | 2021-03-05 |
| ANNUAL REPORT | 2020-04-17 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-03-27 |
| ANNUAL REPORT | 2017-03-20 |
| ANNUAL REPORT | 2016-04-27 |
| ANNUAL REPORT | 2015-03-23 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DELIVERY ORDER | AWARD | 36C24824N0770 | 2024-06-15 | 2025-06-14 | 2025-06-14 | |||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||
| Obligated Amount | 640000.00 |
| Current Award Amount | 640000.00 |
| Potential Award Amount | 640000.00 |
Description
| Title | NURSING HOME SERVICES |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES |
Recipient Details
| Recipient | LADY LAKE NH, L.L.C |
| UEI | ZWRQDWSL6D49 |
| Recipient Address | UNITED STATES, 630 GRIFFIN AVE, LADY LAKE, LAKE, FLORIDA, 321598101 |
| Unique Award Key | CONT_IDV_36C24824D0079_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Award Amounts
| Obligated Amount | 0.00 |
| Potential Award Amount | 3200000.00 |
Description
| Title | ESTIMATED NURSING HOME SERVICES |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES |
Recipient Details
| Recipient | LADY LAKE NH, L.L.C |
| UEI | ZWRQDWSL6D49 |
| Recipient Address | UNITED STATES, 630 GRIFFIN AVE, LADY LAKE, LAKE, FLORIDA, 321598101 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
