| Entity Name: | SUMMERVILLE 3 LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Sep 2004 (20 years ago) |
| Document Number: | M04000003943 |
| FEI/EIN Number | 134287074 |
| Address: | 111 Westwood Place, Brentwood, TN, 37027, US |
| Mail Address: | 111 Westwood Place, Suite 400, Brentwood, TN, 37027, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184834228 | 2007-05-23 | 2016-06-13 | 6737 W WASHINGTON ST STE 2300, MILWAUKEE, WI, 532145650, US | 150 MIDDLE STREET, LAKE MARY, FL, 32746, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 414-918-5000 |
| Fax | 2063014500 |
| Phone | +1 407-321-7550 |
| Fax | 4073217550 |
Authorized person
| Name | BRYAN RICHARDSON |
| Role | EVP, CHIEF ADMIN. OFFICER |
| Phone | 6155648131 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL10162 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 311500000X - Alzheimer Center (Dementia Center) |
| License Number | AL10162 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0089537-00 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| RICCI BENJAMIN J | Vice President | 111 Westwood Place, Brentwood, TN, 37027 |
| Name | Role | Address |
|---|---|---|
| Baier Lucinda M | Chief Executive Officer | 111 Westwood Place, Brentwood, TN, 37027 |
| Name | Role | Address |
|---|---|---|
| White Chad C | Manager | 111 Westwood Place, Brentwood, TN, 37027 |
| Name | Role | Address |
|---|---|---|
| KUSSOW DAWN L | Chief Financial Officer | 111 Westwood Place, Brentwood, TN, 37027 |
| Name | Role | Address |
|---|---|---|
| Kussow Dawn | Executive Vice President | 111 Westwood Place, Brentwood, TN, 37027 |
| Name | Role | Address |
|---|---|---|
| RICCI BENJAMIN J | Director | 111 Westwood Place, Brentwood, TN, 37027 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000117581 | BROOKDALE LAKE MARY | ACTIVE | 2014-11-21 | 2029-12-31 | No data | 150 MIDDLE STREET, LAKE MARY, FL, 32746 |
| G08149900043 | EMERITUS AT LAKE MARY | EXPIRED | 2008-05-27 | 2013-12-31 | No data | 3131 ELLIOTT AVENUE, SUITE 500, SEATTLE, WA, 98121 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-29 | 111 Westwood Place, Suite 400, Brentwood, TN 37027 | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-13 | 111 Westwood Place, Suite 400, Brentwood, TN 37027 | No data |
| REGISTERED AGENT NAME CHANGED | 2007-09-07 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-09-07 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-04 |
| ANNUAL REPORT | 2023-04-23 |
| ANNUAL REPORT | 2022-04-20 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-06-15 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-26 |
| ANNUAL REPORT | 2017-04-29 |
| ANNUAL REPORT | 2016-04-04 |
| ANNUAL REPORT | 2015-04-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
