| Entity Name: | ROYAL HEALTHCARE OF AVON PARK, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 18 Jan 2005 (20 years ago) |
| Date of dissolution: | 18 Dec 2012 (12 years ago) |
| Last Event: | LC WITHDRAWAL |
| Event Date Filed: | 18 Dec 2012 (12 years ago) |
| Document Number: | M05000000251 |
| FEI/EIN Number | 201502213 |
| Address: | 1508 APPLECROFT LANE, COCKEYSVILLE, MD, 33825, US |
| Mail Address: | 1508 APPLECROFT LANE, COCKEYSVILLE, MD, 33825, US |
| ZIP code: | 33825 |
| County: | Highlands |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710049192 | 2006-12-14 | 2020-08-22 | 1213 W STRATFORD RD, AVON PARK, FL, 338258091, US | 1213 W STRATFORD RD, AVON PARK, FL, 338258091, US | |||||||||||||||||||||||||
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| Phone | +1 863-453-6674 |
| Fax | 8634539473 |
Authorized person
| Name | MRS. ANGELA HALL COLEMAN |
| Role | BUSINESS OFFICE MANAGER |
| Phone | 8634536674 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF12290951 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | L7B |
| State | FL |
| Name | Role |
|---|---|
| XX, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| CELTIC CAPITAL PARTNERS, LLC | Manager | No data |
| MOUNTAIN LAKE INVESTORS LLC | Manager | 7823 QUAIL LANDING, SARASOTA, FL, 34240 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC WITHDRAWAL | 2012-12-18 | No data | No data |
| REVOKED FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-09-03 | 1508 APPLECROFT LANE, COCKEYSVILLE, MD 33825 | No data |
| CHANGE OF MAILING ADDRESS | 2008-09-03 | 1508 APPLECROFT LANE, COCKEYSVILLE, MD 33825 | No data |
| CANCEL ADM DISS/REV | 2007-10-11 | No data | No data |
| REVOKED FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| Name | Date |
|---|---|
| LC Withdrawal | 2012-12-18 |
| ANNUAL REPORT | 2008-09-03 |
| REINSTATEMENT | 2007-10-11 |
| ANNUAL REPORT | 2006-05-01 |
| Foreign Limited | 2005-01-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
