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CONWAY LAKES NC, LLC - Florida Company Profile

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Company Details

Entity Name: CONWAY LAKES NC, LLC
Jurisdiction: FLORIDA
Filing Type: Foreign Limited Liability Co.
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 27 Aug 2003 (22 years ago)
Document Number: M03000002857
FEI/EIN Number 760738978

Federal Employer Identification (FEI) Number assigned by the IRS.

Address: 1950 Lower Birmingham Rd, Canton, GA, 30115, US
Mail Address: 1950 Lower Birmingham Rd, Canton, GA, 30115, US
Place of Formation: GEORGIA

Key Officers & Management

Name Role Address
C T CORPORATION SYSTEM Agent -
SBK CAPITAL, L.L.C. Managing Member 3450 Ridgewood Road, NW, ATLANTA, GA, 30327

U.S. Small Business Administration Profile

The U.S. Small Business Administration (SBA) helps Americans start, grow, and build resilient businesses.

Note: SBA was created in 1953 as an independent agency of the federal government to aid, counsel, assist and protect the interests of small business concerns; preserve free competitive enterprise; and maintain and strengthen the overall economy of our nation. SBA reviews Congressional and testifies on behalf of small businesses. It assesses the impact of regulatory burden on small businesses.

Phone Number:
Contact Person:
AJ KUSMIERZ
User ID:
P0595417

Unique Entity ID

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

Unique Entity ID:
H6HJEJAU7GG8
CAGE Code:
3Y3W1
UEI Expiration Date:
2026-03-11

Business Information

Division Name:
CONWAY LAKES NC, LLC
Activation Date:
2025-03-13
Initial Registration Date:
2004-08-02

Commercial and government entity program

The The Commercial And Government Entity Code (CAGE) is assigned by the Department of Defense's Defense Logistics Agency (DLA) and represents your company's physical address for GSA's mailings, payments, and administrative records.

Note: A CAGE Code enables a company to contract with the U.S. government, allowing bid on government contracts and to receive government payments. Also for business this means that it's a Verified business entity and Has a validated physical address.

CAGE number:
3Y3W1
Status:
Active
Type:
Non-Manufacturer
CAGE Update Date:
2025-03-13
CAGE Expiration:
2030-03-13
SAM Expiration:
2026-03-11

Contact Information

POC:
AJ KUSMIERZ

National Provider Identifier

NPI Number:
1649267212
Certification Date:
2022-02-14

Authorized Person:

Name:
MR. SAMUEL B KELLETT
Role:
AS SOLE MEMBER OF SBK CAPITAL LLC
Phone:

Taxonomy:

Selected Taxonomy:
314000000X - Skilled Nursing Facility
Is Primary:
Yes

Contacts:

Fax:
4073847936

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G11000099545 CONWAY LAKES HEALTH & REHABILITATION CENTER ACTIVE 2011-10-10 2026-12-31 - 3450 RIDGEWOOD ROAD NW, ATLANTA, GA, 30327

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-04-24 1950 Lower Birmingham Rd, Canton, GA 30115 -
CHANGE OF MAILING ADDRESS 2024-04-24 1950 Lower Birmingham Rd, Canton, GA 30115 -

Court Cases

Title Case Number Docket Date Status
CONWAY LAKES NC, LLC D/B/A CONWAY LAKES HEALTH AND REHABILITATION CENTER VS AGENCY FOR HEALTH CARE ADMINISTRATION 5D2021-2994 2021-12-07 Closed
Classification NOA Final - Administrative - Other
Court 5th District Court of Appeal
Originating Court Circuit Court for the Ninth Judicial Circuit, Orange County
DOAH21-1832

Administrative Agency
F1219-0659-001

Parties

Name CONWAY LAKES NC, LLC
Role Appellant
Status Active
Representations Taylor Huston
Name Conway Lakes Health and Rehabilitation Center
Role Appellant
Status Active
Name Clerk Agency Health Care
Role Appellee
Status Active
Representations Tracy Cooper George, Eugenia Keough Rains, Richard Santurri
Name Clerk Division of Administrative
Role Appellee
Status Active

Docket Entries

Docket Date 2021-12-07
Type Misc. Events
Subtype Fee Status
Description FP:Fee Paid Through Portal
On Behalf Of Conway Lakes NC, LLC
Docket Date 2021-12-07
Type Order
Subtype Order on Filing Fee
Description Order to pay filing fee - Administrative (300)
Docket Date 2022-03-23
Type Brief
Subtype Answer Brief
Description Appellee's Answer Brief
On Behalf Of Clerk Agency Health Care
Docket Date 2022-02-22
Type Order
Subtype Order Discharging Show Cause Order
Description ORD-Discharging Show Cause ~ RESPONSE ACKNOWLEDGED; IB ACCEPTED; OTSC DISCHARGED
Docket Date 2022-02-21
Type Brief
Subtype Initial Brief
Description Initial Brief on Merits
On Behalf Of Conway Lakes NC, LLC
Docket Date 2022-02-21
Type Response
Subtype Response
Description RESPONSE ~ PER 2/15 ORDER
On Behalf Of Conway Lakes NC, LLC
Docket Date 2022-02-18
Type Notice
Subtype Notice of Appearance
Description Notice of Appearance
On Behalf Of Clerk Agency Health Care
Docket Date 2022-02-15
Type Order
Subtype Show Cause
Description Show Cause Lack of Prosecution, Initial Brief ~ AA W/IN 10 DYS
Docket Date 2021-12-20
Type Record
Subtype Record on Appeal
Description Received Records ~ 244 PAGES
On Behalf Of Clerk Division of Administrative
Docket Date 2021-12-15
Type Order
Subtype Order
Description Miscellaneous Order ~ RESPONSE ACKNOWLEDGED; APPEAL SHALL NOT BE RESTRICTED
Docket Date 2021-12-14
Type Response
Subtype Response
Description RESPONSE ~ PER 12/8 ORDER- JOINT RESPONSE
On Behalf Of Clerk Agency Health Care
Docket Date 2021-12-09
Type Notice
Subtype Notice of Appearance
Description Notice of Appearance
On Behalf Of Clerk Agency Health Care
Docket Date 2021-12-08
Type Order
Subtype Order
Description Miscellaneous Order ~ PARTIES W/IN 10 DYS ADVISE RE: RESTRICT/MEDICAID
Docket Date 2021-12-07
Type Letter
Subtype Acknowledgment Letter
Description Acknowledgement Letter 1
Docket Date 2021-12-07
Type Notice
Subtype Notice of Appeal
Description Notice of Appeal Filed ~ FILED BELOW 12/6/21
On Behalf Of Conway Lakes NC, LLC
Docket Date 2022-10-25
Type Record
Subtype Returned Records
Description Returned Records ~ NO RECORD E-FILED
Docket Date 2022-10-25
Type Mandate
Subtype Mandate
Description Mandate
Docket Date 2022-10-04
Type Disposition by Opinion
Subtype Affirmed
Description Affirmed - Per Curiam Affirmed ~ PCA
Docket Date 2022-05-17
Type Notice
Subtype Notice
Description NOTICE OF PANEL ASSIGNMENT

Documents

Name Date
ANNUAL REPORT 2024-04-24
ANNUAL REPORT 2023-04-10
ANNUAL REPORT 2022-03-15
ANNUAL REPORT 2021-01-27
ANNUAL REPORT 2020-04-27
ANNUAL REPORT 2019-03-05
ANNUAL REPORT 2018-04-16
ANNUAL REPORT 2017-04-11
ANNUAL REPORT 2016-03-30
ANNUAL REPORT 2015-03-23

USAspending Awards / Contracts

Procurement Instrument Identifier:
36C24825N0550
Award Or Idv Flag:
AWARD
Award Type:
DELIVERY ORDER
Action Obligation:
1250000.00
Base And Exercised Options Value:
1250000.00
Base And All Options Value:
1250000.00
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2025-04-18
Description:
COMMUNITY NURSING HOME SERVICES
Naics Code:
623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product Or Service Code:
Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES
Procurement Instrument Identifier:
36C24824N0575
Award Or Idv Flag:
AWARD
Award Type:
DELIVERY ORDER
Action Obligation:
1250000.00
Base And Exercised Options Value:
1250000.00
Base And All Options Value:
1250000.00
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2024-04-18
Description:
COMMUNITY NURSING HOME SERVICES
Naics Code:
623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product Or Service Code:
Q402: MEDICAL- NURSING HOME CARE CONTRACTS
Procurement Instrument Identifier:
36C24823N0278
Award Or Idv Flag:
AWARD
Award Type:
DELIVERY ORDER
Action Obligation:
1250000.00
Base And Exercised Options Value:
1250000.00
Base And All Options Value:
1250000.00
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2023-04-18
Description:
EO14042 | COMMUNITY NURSING HOME SERVICES
Naics Code:
623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product Or Service Code:
Q402: MEDICAL- NURSING HOME CARE CONTRACTS

USAspending Awards / Financial Assistance

Date:
2020-04-30
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
1545100.00
Total Face Value Of Loan:
1545100.00

Paycheck Protection Program

Date Approved:
2020-04-30
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
1545100
Current Approval Amount:
1545100
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
1561924.42

Motor Carrier Census

DBA Name:
CONWAY LAKES REHABILITATION CENTER
Carrier Operation:
Intrastate Non-Hazmat
Add Date:
2015-01-15
Operation Classification:
Priv. Pass. (Business), Priv. Pass.(Non-business)
power Units:
2
Drivers:
2
Inspections:
0
FMCSA Link:

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Date of last update: 02 Jun 2025

Sources: Florida Department of State