| Entity Name: | CYPRESS COVE CARE CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Sep 2000 (24 years ago) |
| Document Number: | M00000001941 |
| FEI/EIN Number | 621832454 |
| Address: | 700 SE Dr Martin Luther King Jr Ave, CRYSTAL RIVER, FL, 34429, US |
| Mail Address: | 700 SE Dr Martin Luther King Jr Ave, CRYSTAL RIVER, FL, 34429, US |
| ZIP code: | 34429 |
| County: | Citrus |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932100229 | 2005-08-09 | 2023-09-07 | 700 SE DR. MARTIN LUTHER KING AVE, CRYSTAL RIVER, FL, 344294855, US | 700 SE DR. MARTIN LUTHER KING JR. AVENUE, CRYSTAL RIVER, FL, 344294855, US | |||||||||||||||||||||||||
|
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| Phone | +1 352-795-8832 |
| Fax | 3527950490 |
Authorized person
| Name | SCOTT FISHER |
| Role | CFO |
| Phone | 3524170360 |
Taxonomy
| Taxonomy Code | 313M00000X - Nursing Facility/Intermediate Care Facility |
| License Number | SNF1115096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022894000 |
| State | FL |
| Name | Role |
|---|---|
| NRAI SERVICES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| Fisher Scott | Secretary | 7056 W. GULF TO LAKE HWY., CRYSTAL RIVER, FL, 34429 |
| Name | Role | Address |
|---|---|---|
| Shatz Jim | President | 7056 West Gulf to Lake Highway, Crystal River, FL, 34429 |
| Name | Role | Address |
|---|---|---|
| White Josh | Manager | 7056 West Gulf to Lake Hwy, Crystal River, FL, 34429 |
| Jackson Brian | Manager | 7056 West Gulf to Lake Hwy, Crystal River, FL, 34429 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000157686 | CYPRESS COVE CARE CENTER | ACTIVE | 2022-12-21 | 2027-12-31 | No data | 700 SE DR MARTIN LUTHER KING JR AVE, CRYSTAL RIVER, FL, 34429 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-10-04 | 700 SE Dr Martin Luther King Jr Ave, CRYSTAL RIVER, FL 34429 | No data |
| CHANGE OF MAILING ADDRESS | 2022-10-04 | 700 SE Dr Martin Luther King Jr Ave, CRYSTAL RIVER, FL 34429 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-02-11 | 1200 South Pine Island Road, Plantation, FL 33324 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-03-20 |
| ANNUAL REPORT | 2022-04-14 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-04-30 |
| ANNUAL REPORT | 2019-04-08 |
| ANNUAL REPORT | 2018-03-26 |
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-01-27 |
| ANNUAL REPORT | 2015-04-27 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
