| Entity Name: | 3865 TAMPA ROAD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| 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: | M01000001250 |
| FEI/EIN Number |
061621885
Federal Employer Identification (FEI) Number assigned by the IRS. |
| 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 | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487678132 | 2006-07-26 | 2018-03-23 | 101 SUN AVE NE, COMPLIANCE DEPARTMENT, ALBUQUERQUE, NM, 871094373, US | 3865 TAMPA RD, OLDSMAR, FL, 346773008, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 505-468-5604 |
| Fax | 5054684681 |
| Phone | +1 813-855-4661 |
| Fax | 8138542129 |
Authorized person
| Name | MICHAEL THEODORE BERG |
| Role | VP AND ASST SECRETARY |
| Phone | 5054684742 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF 1591096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025346400 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| FLORIDA HOLDINGS III, LLC | Auth |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000026087 | WEST BAY OF TAMPA | EXPIRED | 2013-03-15 | 2018-12-31 | - | 3865 TAMPA ROAD, OLDSMAR, FL, 34677 |
| G08336700033 | WEST BAY CARE AND REHABILITATION CENTER | EXPIRED | 2008-12-01 | 2013-12-31 | - | 101 SUN AVE. NE, ALBUQUERQUE, NM, 87109 |
| G08325900247 | WEST BARY CARE AND REHABILITATION CENTER | EXPIRED | 2008-11-20 | 2013-12-31 | - | 3865 TAMPA ROAD, OLDSMAR, FL, 34677 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| WITHDRAWAL | 2023-12-20 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2013-04-29 | 101 EAST STATE STREET, KENNETT SQUARE, PA 19348 | - |
| Name | Date |
|---|---|
| WITHDRAWAL | 2023-12-20 |
| ANNUAL REPORT | 2023-03-22 |
| ANNUAL REPORT | 2022-04-05 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-01-07 |
| ANNUAL REPORT | 2019-03-12 |
| ANNUAL REPORT | 2018-01-02 |
| ANNUAL REPORT | 2017-01-04 |
| ANNUAL REPORT | 2016-01-18 |
| ANNUAL REPORT | 2015-04-13 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
