| Entity Name: | HQM OF SURREY PLACE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 12 Aug 2002 (22 years ago) |
| Date of dissolution: | 13 Jul 2009 (16 years ago) |
| Last Event: | LC WITHDRAWAL |
| Event Date Filed: | 13 Jul 2009 (16 years ago) |
| Document Number: | M02000002117 |
| FEI/EIN Number | 611420655 |
| Mail Address: | PO BOX 31809, PALM BEACH GARDENS, FL, 33420 |
| Address: | 2979 PGA BOULEVARD, PALM BEACH GARDENS, FL, 33410 |
| ZIP code: | 33410 |
| County: | Palm Beach |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366421836 | 2006-01-12 | 2009-02-24 | 110 LEE AVE SE, LIVE OAK, FL, 320649504, US | 110 LEE AVE SE, LIVE OAK, FL, 320649504, US | |||||||||||||||||||||||
|
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| Phone | +1 386-364-5961 |
Authorized person
| Name | MR. PAUL WALCZAK |
| Role | CEO |
| Phone | 5616270664 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1540096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025710900 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATE CREATIONS NETWORK INC. | Agent |
| Name | Role |
|---|---|
| HOME QUALITY MANAGEMENT, INC. | Managing Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC WITHDRAWAL | 2009-07-13 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2008-03-31 | 2979 PGA BOULEVARD, PALM BEACH GARDENS, FL 33410 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-08-12 | CORPORATE CREATIONS NETWORK, INC. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-08-12 | 11380 PROSPERITY FARMS ROAD #221E, PALM BEACH GARDENS, FL 33410 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-03-04 | 2979 PGA BOULEVARD, PALM BEACH GARDENS, FL 33410 | No data |
| CANCEL ADM DISS/REV | 2005-03-04 | No data | No data |
| REVOKED FOR ANNUAL REPORT | 2004-10-01 | No data | No data |
| Name | Date |
|---|---|
| LC Withdrawal | 2009-07-13 |
| ANNUAL REPORT | 2008-03-31 |
| ANNUAL REPORT | 2007-04-30 |
| ANNUAL REPORT | 2006-04-28 |
| Reg. Agent Change | 2005-08-12 |
| REINSTATEMENT | 2005-03-04 |
| ANNUAL REPORT | 2003-02-18 |
| Foreign Limited | 2002-08-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
