| Entity Name: | AHC SOUTHLAND-MELBOURNE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 31 Mar 2006 (19 years ago) |
| Date of dissolution: | 11 Sep 2023 (a year ago) |
| Last Event: | WITHDRAWAL |
| Event Date Filed: | 11 Sep 2023 (a year ago) |
| Document Number: | M06000001880 |
| FEI/EIN Number | 20-4625955 |
| Address: | 111 WESTWOOD PLACE, SUITE 400, BRENTWOOD, TN 37027 |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154487825 | 2006-12-28 | 2016-05-03 | 6737 W WASHINGTON ST, SUITE 2300, MILWAUKEE, WI, 532145647, US | 2680 CROTON RD, MELBOURNE, FL, 329353576, US | |||||||||||||||||||
|
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| Phone | +1 321-255-5443 |
Authorized person
| Name | BRYAN D RICHARDSON |
| Role | EXECUTIVE VICE PRESIDENT |
| Phone | 6152212250 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 690889600 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Baier, Lucinda M | Manager | 111 WESTWOOD PLACE, SUITE 400 BRENTWOOD, TN 37027 |
| FISCHER, LAURA E | Manager | 111 WESTWOOD PLACE, SUITE 400 BRENTWOOD, TN 37027 |
| White, Chad C | Manager | 111 WESTWOOD PLACE, SUITE 400 BRENTWOOD, TN 37027 |
| RICCI, BENJAMIN J | Manager | 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 |
|---|---|---|
| Baier, Lucinda M | Chief Executive Officer | 111 WESTWOOD PLACE, SUITE 400 BRENTWOOD, TN 37027 |
| Name | Role | Address |
|---|---|---|
| FISCHER, LAURA E | Director | 111 WESTWOOD PLACE, SUITE 400 BRENTWOOD, TN 37027 |
| RICCI, BENJAMIN J | Director | 111 WESTWOOD PLACE, SUITE 400 BRENTWOOD, TN 37027 |
| Name | Role | Address |
|---|---|---|
| FISCHER, LAURA E | Vice President | 111 WESTWOOD PLACE, SUITE 400 BRENTWOOD, TN 37027 |
| Leskowicz, Joanne | Vice President | 6737 W Washington Street, Suite 2300 MILWAUKEE, WI 53214 |
| RICCI, BENJAMIN J | Vice 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 | Chief Financial Officer | 6737 W WASHINGTON ST STE 2300, MILWAUKEE, WI 53214 |
| Name | Role | Address |
|---|---|---|
| Leskowicz, Joanne | Secretary | 6737 W Washington Street, Suite 2300 MILWAUKEE, WI 53214 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000023088 | BROOKDALE EAU GALLIE | ACTIVE | 2015-03-04 | 2025-12-31 | No data | 111 WESTWOOD PLACE, SUITE 400, BRENTWOOD, TN, 37027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| WITHDRAWAL | 2023-09-11 | No data | No data |
| LC STMNT OF RA/RO CHG | 2016-10-04 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-10-04 | 1201 HAYS STREET, TALLAHASSEE, FL 32301 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-04-01 | 111 WESTWOOD PLACE, SUITE 400, BRENTWOOD, TN 37027 | No data |
| Name | Date |
|---|---|
| WITHDRAWAL | 2023-09-11 |
| ANNUAL REPORT | 2023-04-18 |
| ANNUAL REPORT | 2022-04-19 |
| ANNUAL REPORT | 2021-04-19 |
| ANNUAL REPORT | 2020-06-12 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-04-27 |
| CORLCRACHG | 2016-10-04 |
| ANNUAL REPORT | 2016-03-13 |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
