| Entity Name: | ORANGE PARK FACILITY OPERATIONS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Active |
| Date Filed: | 11 Jul 2006 (19 years ago) |
| Document Number: | M06000003825 |
| FEI/EIN Number | 20-5112395 |
| Address: | 850 CONCOURSE PKWY S STE 250, MAITLAND, FL 32751 |
| Mail Address: | 1040 CROWN POINTE PKWY,, STE 600, ATLANTA, GA 30338-4741 |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | OHIO |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619990538 | 2006-07-25 | 2023-07-28 | 1215 KINGSLEY AVE, ORANGE PARK, FL, 320734631, US | 1215 KINGSLEY AVE, ORANGE PARK, FL, 320734631, US | |||||||||||||||||||||||||
|
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| Phone | +1 904-269-8922 |
| Fax | 9042642253 |
Authorized person
| Name | CRAIG E ROBINSON |
| Role | MANAGER |
| Phone | 4072159800 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1016095 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008040200 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| LV CHC HOLDINGS I, LLC | MEMBER | 850 CONCOURSE PKWY S STE 250, MAITLAND, FL 32751 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000054717 | ORANGE PARK HEALTH AND REHABILITATION | ACTIVE | 2023-05-01 | 2028-12-31 | No data | 1040 CROWN POINTE PKWY, STE 600, ATLANTA, GA, 30338 |
| G21000137311 | RAYDIANT HEALTH CARE OF ORANGE PARK | ACTIVE | 2021-10-12 | 2026-12-31 | No data | 1040 CROWN POINTE PARKWAY, SUITE 600, ATLANTA, GA, 30338 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-29 | 850 CONCOURSE PKWY S STE 250, MAITLAND, FL 32751 | No data |
| CHANGE OF MAILING ADDRESS | 2018-06-20 | 850 CONCOURSE PKWY S STE 250, MAITLAND, FL 32751 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-04-23 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-23 | 1201 HAYS STREET, TALLAHASEE, FL 32301 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-04-21 |
| ANNUAL REPORT | 2020-04-20 |
| ANNUAL REPORT | 2019-04-21 |
| ANNUAL REPORT | 2018-04-25 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-04-27 |
| ANNUAL REPORT | 2015-04-16 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
