| Entity Name: | SUMMERVILLE 16 LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Active |
| Date Filed: | 16 May 2005 (20 years ago) |
| Document Number: | M05000002589 |
| FEI/EIN Number | 20-2547804 |
| Address: | 111 Westwood Place, Suite 400, Brentwood, TN 37027 |
| Mail Address: | 111 Westwood Place, Suite 400, Brentwood, TN 37027 |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447427703 | 2008-05-14 | 2016-05-13 | 6737 W WASHINGTON ST, SUITE 2300, MILWAUKEE, WI, 532145647, US | 1700 NE INDIAN RIVER DR, JENSEN BEACH, FL, 349575853, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 772-225-1355 |
Authorized person
| Name | BRYAN RICHARDSON |
| Role | EVP, CHIEF ADMIN. OFFICER |
| Phone | 6155648131 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL9294 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 311500000X - Alzheimer Center (Dementia Center) |
| License Number | AL9294 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0118952-00 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Baier, Lucinda M | Chief Executive Officer | 111 Westwood Place, Suite 400 Brentwood, TN 37027 |
| Name | Role | Address |
|---|---|---|
| Baier, Lucinda M | President | 111 Westwood Place, Suite 400 Brentwood, TN 37027 |
| Name | Role | Address |
|---|---|---|
| White, Chad C. | EVP AND SECRETARY | 111 Westwood Place, Suite 400 Brentwood, TN 37027 |
| Name | Role | Address |
|---|---|---|
| KUSSOW, DAWN L | Chief Financial Officer | 111 Westwood Place, Suite 400 Brentwood, TN 37027 |
| Name | Role | Address |
|---|---|---|
| Kussow, Dawn | Executive Vice President | 111 Westwood Place, Suite 400 Brentwood, TN 37027 |
| Name | Role | Address |
|---|---|---|
| RICCI, BENJAMIN J | Director | 111 Westwood Place, Suite 400 Brentwood, TN 37027 |
| Name | Role | Address |
|---|---|---|
| RICCI, BENJAMIN J | Vice President | 111 Westwood Place, Suite 400 Brentwood, TN 37027 |
| Name | Role | Address |
|---|---|---|
| SUMMERVILLE INVESTORS LLC | Managing Member | 111 Westwood Place, Suite 400 Brentwood, TN 37027 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000012749 | BROOKDALE JENSEN BEACH | ACTIVE | 2015-02-04 | 2025-12-31 | No data | 111 WESTWOOD PL STE 400, BRENTWOOD, TN, 37027 |
| 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: 29 Jan 2025
Sources: Florida Department of State
