| Entity Name: | NORTH FORT MYERS FACILITY OPERATIONS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Jul 2006 (19 years ago) |
| Document Number: | M06000003836 |
| FEI/EIN Number | 205112262 |
| Address: | 850 CONCOURSE PKWY S STE 250, MAITLAND, FL, 32751, US |
| Mail Address: | 1040 CROWN POINTE PKWY,, STE 600, ATLANTA, GA, 30338-4741, US |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | OHIO |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013930031 | 2006-07-25 | 2023-07-14 | 991 PONDELLA RD, NORTH FORT MYERS, FL, 339033500, US | 991 PONDELLA RD, NORTH FORT MYERS, FL, 339033500, US | |||||||||||||||||||||||||
|
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| Phone | +1 239-995-8809 |
| Fax | 2399951253 |
Authorized person
| Name | BRIAN BRINKERHOFF |
| Role | MANAGER |
| Phone | 4074296100 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1444096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008040000 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| LV CHC HOLDINGS I, LLC | Member | 850 CONCOURSE PARKWAY S STE 250, MAITLAND, FL, 32751 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000137194 | RAYDIANT HEALTH CARE OF NORTH FORT MYERS | 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, TALLAHASSEE, FL 32301 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J14001051381 | LAPSED | 14-SC-001013 | LEE COUNTY COURT | 2014-11-24 | 2019-12-08 | $1066.98 | ROGER DEAN CHEVROLET OF CAPE CORAL, 191 SW PINE ISLAND ROAD, CAPE CORAL, FL 33991 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-03-25 |
| 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 Feb 2025
Sources: Florida Department of State
