| Entity Name: | 2900 TWELFTH STREET NORTH, 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: | M01000001246 |
| FEI/EIN Number | 061621879 |
| 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 | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275556383 | 2006-07-26 | 2016-01-04 | 101 E STATE ST, KENNETT SQUARE, PA, 193483109, US | 2900 12TH ST N, NAPLES, FL, 341034528, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 505-468-4742 |
| Fax | 5054688742 |
| Phone | +1 239-261-2554 |
| Fax | 2392614540 |
Authorized person
| Name | MICHAEL TENNESSEE BERG |
| Role | ASSISTANT SECRETARY |
| Phone | 5054684742 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF 12840962 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025684600 |
| 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 |
|---|---|---|---|---|---|---|
| G13000026053 | LAKESIDE PAVILION | EXPIRED | 2013-03-15 | 2018-12-31 | No data | 2900 12TH STREET NORTH, NAPLES, FL, 34103 |
| G08337700005 | LAKESIDE PAVILION CARE AND REHABILITATION CENTER | EXPIRED | 2008-12-02 | 2013-12-31 | No data | 101 SUN AVE. NE, ALBUQUERQUE, NM, 87109 |
| G08325900256 | LAKESIDE PAVILION | EXPIRED | 2008-11-20 | 2013-12-31 | No data | 2900 TWELFTH STREET NORTH, NAPLES, FL, 34103 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| WITHDRAWAL | 2023-12-20 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-04-29 | 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
