| Entity Name: | DEEP CREEK RNC, 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) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 08 Oct 2003 (21 years ago) |
| Document Number: | M03000002858 |
| FEI/EIN Number |
760738973
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 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679560262 | 2005-09-29 | 2018-06-12 | 25325 RAMPART BLVD, PORT CHARLOTTE, FL, 339836404, US | 25325 RAMPART BLVD, PORT CHARLOTTE, FL, 33983, US | |||||||||||||||||||||||||||||
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| Phone | +1 941-629-7466 |
| Fax | 9416299053 |
Authorized person
| Name | MR. SAMUEL B KELLETT |
| Role | MANAGING MEMBER OF SBK CAPITAL LLC |
| Phone | 4042337048 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF14260961 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | VA |
| Number | V516P-6820 |
| Issuer | MEDICAID |
| Number | 0319325 00 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SBK CAPITAL, L.L.C. | Managing Member | 3450 Ridgewood Road, NW, ATLANTA, GA, 30327 |
| C T CORPORATION SYSTEM | Agent | - |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08350700125 | PORT CHARLOTTE REHABILITATION CENTER | ACTIVE | 2008-12-15 | 2028-12-31 | - | 1950 LOWER BIRMINGHAM ROAD, CANTON, GA, 30115 |
| 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 | - |
| NAME CHANGE AMENDMENT | 2003-10-08 | DEEP CREEK RNC, LLC | - |
| 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 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DELIVERY ORDER | AWARD | 36C24825N0052 | 2024-10-01 | 2025-09-30 | 2025-09-30 | |||||||||||||||||||||||||
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| Obligated Amount | 510987.93 |
| Current Award Amount | 510987.93 |
| Potential Award Amount | 510987.93 |
Description
| Title | NURSING HOME SERVICES |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES |
Recipient Details
| Recipient | DEEP CREEK RNC LLC |
| UEI | PXAFH98L75V3 |
| Recipient Address | UNITED STATES, 25325 RAMPART BLVD, PORT CHARLOTTE, CHARLOTTE, FLORIDA, 339836404 |
| Unique Award Key | CONT_IDV_36C24824D0004_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Award Amounts
| Obligated Amount | 0.00 |
| Potential Award Amount | 2554939.65 |
Description
| Title | ESTIMATED NURSING HOME SERVICES |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES |
Recipient Details
| Recipient | DEEP CREEK RNC LLC |
| UEI | PXAFH98L75V3 |
| Recipient Address | UNITED STATES, 25325 RAMPART BLVD, PORT CHARLOTTE, CHARLOTTE, FLORIDA, 339836404 |
| Unique Award Key | CONT_IDV_VA248BO0167_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Description
| Title | PROVIDE CARE FOR VA BENEFICIARIES MEDICAID RATE UPDATE |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | DEEP CREEK RNC LLC |
| UEI | PXAFH98L75V3 |
| Legacy DUNS | 145887506 |
| Recipient Address | 25325 RAMPART BLVD, PT CHARLOTTE, 339836404, UNITED STATES |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 7329087309 | 2020-04-30 | 0455 | PPP | 25325 Rampart Blvd, PUNTA GORDA, FL, 33983-6404 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Status | User ID | Name of Firm | Trade Name | UEI | Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Active | P0587540 | DEEP CREEK RNC LLC | PORT CHARLOTTE REHABILITATION CENTER | PXAFH98L75V3 | 25325 RAMPART BLVD, PORT CHARLOTTE, FL, 33983-6404 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| HUBZone Certified | No |
| Women Owned Certified | No |
| Women Owned Pending | No |
| Economically Disadvantaged Women Owned Certified | No |
| Economically Disadvantaged Women Owned Pending | No |
| Veteran-Owned Small Business Certified | No |
| Veteran-Owned Small Business Joint Venture | No |
| Service-Disabled Veteran-Owned Small Business Certified | No |
| Service-Disabled Veteran-Owned Small Business Joint Venture | No |
Bonding Levels
| Description | Construction Bonding Level (per contract) |
| Level | (none given) |
| Description | Construction Bonding Level (aggregate) |
| Level | (none given) |
| Description | Service Bonding Level (per contract) |
| Level | (none given) |
| Description | Service Bonding Level (aggregate) |
| Level | (none given) |
NAICS Codes with Size Determinations by NAICS
| Primary | Yes |
| Code | 623110 |
| NAICS Code's Description | Nursing Care Facilities (Skilled Nursing Facilities) |
| Small | Yes |
Export Profile (Trade Mission Online)
| Exporter | Firm hasn't answered this question yet |
| Export Business Activities | (none given) |
| Exporting to | (none given) |
| Desired Export Business Relationships | (none given) |
| Description of Export Objective(s) | (none given) |
| USDOT Number | Carrier Operation | MCS-150 Form Date | MCS-150 Mileage | MCS-150 Year | Power Units | Drivers | Operation Classification | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2586200 | Intrastate Non-Hazmat | 2023-01-19 | 20000 | 2022 | 0 | 3 | Private(Property), Priv. Pass.(Non-business) | |||||||||||||||||||||||||||||||||||||||||||||||||||
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| Total Number of Inspections for the measurement period (24 months) | 0 |
| Driver Fitness BASIC Serious Violation Indicator | No |
| Vehicle Maintenance BASIC Acute/Critical Indicator | No |
| Unsafe Driving BASIC Acute/Critical Indicator | No |
| Driver Fitness BASIC Roadside Performance measure value | 0 |
| Hours-of-Service (HOS) Compliance BASIC Roadside Performance measure value | 0 |
| Total Number of Driver Inspections for the measurment period | 0 |
| Vehicle Maintenance BASIC Roadside Performance measure value | 0 |
| Total Number of Vehicle Inspections for the measurement period | 0 |
| Controlled Substances and Alcohol BASIC Roadside Performance measure value | 0 |
| Unsafe Driving BASIC Roadside Performance Measure Value | 0 |
| Number of inspections with at least one Driver Fitness BASIC violation | 0 |
| Number of inspections with at least one Hours-of-Service BASIC violation | 0 |
| Total Number of Driver Inspections containing at least one Driver Out-of-Service Violation | 0 |
| Number of inspections with at least one Vehicle Maintenance BASIC violation | 0 |
| Total Number of Vehicle Inspections containing at least one Vehicle Out-of-Service violation | 0 |
| Number of inspections with at least one Controlled Substances and Alcohol BASIC violation | 0 |
| Number of inspections with at least one Unsafe Driving BASIC violation | 0 |
Date of last update: 03 Mar 2025
Sources: Florida Department of State
