| Entity Name: | SUMMERVILLE AT GOLDEN POND LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Jan 2006 (19 years ago) |
| Document Number: | M06000000299 |
| FEI/EIN Number | 204130558 |
| 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 | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629287420 | 2007-05-21 | 2016-06-13 | 6737 W WASHINGTON ST STE 2300, MILWAUKEE, WI, 532145650, US | 450 67TH STREET NORTH, BRADENTON, FL, 34209, US | |||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 414-918-5000 |
| Fax | 2063014500 |
| Phone | +1 941-794-5657 |
| Fax | 9417983521 |
Authorized person
| Name | BYRAN RICHARDSON |
| Role | EVP, CHIEF ADMIN. OFFICER |
| Phone | 6155648131 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | No |
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL4712 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 06905137-00 |
| State | FL |
| Issuer | MEDICAID |
| Number | 140353200 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Baier Lucinda M | Chief Executive Officer | 111 Westwood Place, Brentwood, TN, 37027 |
| Name | Role | Address |
|---|---|---|
| White Chad C | Executive Vice President | 111 Westwood Place, Brentwood, TN, 37027 |
| Kussow Dawn | Executive Vice President | 111 Westwood Place, Brentwood, TN, 37027 |
| Name | Role | Address |
|---|---|---|
| KUSSOW DAWN L | Chief Financial Officer | 111 Westwood Place, Brentwood, TN, 37027 |
| Name | Role | Address |
|---|---|---|
| RICCI BENJAMIN | Director | 111 Westwood Place, Brentwood, TN, 37027 |
| Name | Role | Address |
|---|---|---|
| RICCI BENJAMIN | Vice President | 111 Westwood Place, Brentwood, TN, 37027 |
| Name | Role |
|---|---|
| SUMMERVILLE SENIOR LIVING, INC. | Managing Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000012833 | BROOKDALE PALMA SOLA | 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 | 2023-04-24 |
| ANNUAL REPORT | 2022-04-20 |
| ANNUAL REPORT | 2021-04-26 |
| 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: 03 Feb 2025
Sources: Florida Department of State
