| Entity Name: | 1240 PINEBROOK ROAD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 04 Jun 2001 (24 years ago) |
| Date of dissolution: | 20 Dec 2023 (a year ago) |
| Last Event: | WITHDRAWAL |
| Event Date Filed: | 20 Dec 2023 (a year ago) |
| Document Number: | M01000001245 |
| FEI/EIN Number | 061621880 |
| Address: | 101 EAST STATE STREET, KENNETT SQUARE, PA, 19348, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134143845 | 2006-07-26 | 2009-10-01 | 101 SUN AVE NE, COMPLIANCE DEPARTMENT, ALBUQUERQUE, NM, 871094373, US | 1240 PINEBROOK RD, VENICE, FL, 342856421, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 505-468-5604 |
| Fax | 5054684681 |
| Phone | +1 941-488-6733 |
| Fax | 9414847924 |
Authorized person
| Name | WILLIAM A MATHIES |
| Role | PRESIDENT DIRECTOR |
| Phone | 5058213355 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF 14390962 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025266200 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role |
|---|---|
| FLORIDA HOLDINGS II, LLC | Auth |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000026071 | PINEBROOK CENTER | EXPIRED | 2013-03-15 | 2018-12-31 | No data | 1240 PINEBROOK ROAD, VENICE, FL, 34285 |
| G08325900258 | PINEBROOK CARE AND REHABILITATION CENTER | EXPIRED | 2008-11-20 | 2013-12-31 | No data | 1240 PINEBROOK ROAD, VENICE, FL, 34292 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| WITHDRAWAL | 2023-12-20 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-04-29 | 101 EAST STATE STREET, KENNETT SQUARE, PA 19348 | No data |
| Name | Date |
|---|---|
| WITHDRAWAL | 2023-12-20 |
| ANNUAL REPORT | 2023-03-22 |
| ANNUAL REPORT | 2022-04-05 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-04-21 |
| ANNUAL REPORT | 2019-03-11 |
| ANNUAL REPORT | 2018-01-02 |
| ANNUAL REPORT | 2017-01-04 |
| ANNUAL REPORT | 2016-01-18 |
| ANNUAL REPORT | 2015-04-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
