| Entity Name: | LAKE PARKER FACILITY OPERATIONS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Jul 2006 (19 years ago) |
| Document Number: | M06000003837 |
| FEI/EIN Number | 205109064 |
| Mail Address: | 1040 CROWN POINTE PKWY, STE 600, ATLANTA, GA, 30338-4741, US |
| Address: | 850 CONCOURSE PKWY S, MAITLAND, FL, 32751, US |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336162395 | 2006-07-25 | 2023-11-27 | 2020 W LAKE PARKER DR, LAKELAND, FL, 338055005, US | 2020 W LAKE PARKER DR, LAKELAND, FL, 338055005, US | |||||||||||||||||||||||||
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| Phone | +1 863-682-7580 |
| Fax | 8636839564 |
Authorized person
| Name | KENNETH USSERY |
| Role | VP |
| Phone | 4075711550 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF10150962 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008039300 |
| 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 |
|---|---|---|---|---|---|---|
| G10000003567 | CONSULATE HEALTH CARE AT LAKE PARKER | ACTIVE | 2010-01-13 | 2025-12-31 | No data | 2020 W. LAKE PARKER DRIVE, LAKELAND, FL, 33805 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-07-14 | 850 CONCOURSE PKWY S, STE 250, MAITLAND, FL 32751 | No data |
| CHANGE OF MAILING ADDRESS | 2018-06-19 | 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 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-26 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-04-21 |
| ANNUAL REPORT | 2020-04-20 |
| ANNUAL REPORT | 2019-04-21 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-04-25 |
| ANNUAL REPORT | 2015-04-16 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
