| Entity Name: | PRUITTHEALTH - SANTA ROSA LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 Jan 2007 (18 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 23 Aug 2016 (8 years ago) |
| Document Number: | M07000000520 |
| FEI/EIN Number | 020615724 |
| Address: | 5530 Northrop Road, Milton, FL, 32570-8701, US |
| Mail Address: | 5530 Northrop Road, Milton, FL, 32570-8701, US |
| Place of Formation: | GEORGIA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316992605 | 2006-05-24 | 2021-06-03 | 1626 JEURGENS CT, NORCROSS, GA, 300932219, US | 5530 NORTHROP ROAD, MILTON, FL, 325708701, US | |||||||||||||||||||||||||||||
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| Phone | +1 770-279-6200 |
| Fax | 7068860542 |
| Phone | +1 850-983-8888 |
| Fax | 8509838880 |
Authorized person
| Name | NEIL L. PRUITT JR. |
| Role | CHAIRMAN & CEO OF MGR |
| Phone | 7702796200 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF130471024 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025933100 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| UNITED HEALTH SERVICES OF FLORIDA, INC. | Manager | No data |
| PRUITT NEIL LJr. | Manager | 1626 Jeurgens Court, Norcross, GA, 30093 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08155900247 | UNIHEALTH POST-ACUTE CARE - SANTA ROSA | EXPIRED | 2008-06-03 | 2013-12-31 | No data | P O BOX 1210, TOCCOA, GA, 30577 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-23 | 5530 Northrop Road, Milton, FL 32570-8701 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-23 | 5530 Northrop Road, Milton, FL 32570-8701 | No data |
| LC STMNT OF RA/RO CHG | 2016-08-23 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-08-23 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-08-23 | 1201 HAYS STREET, TALLAHASSEE, FL 32301 | No data |
| LC NAME CHANGE | 2013-12-31 | PRUITTHEALTH - SANTA ROSA LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-23 |
| ANNUAL REPORT | 2023-02-22 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-19 |
| ANNUAL REPORT | 2020-05-01 |
| ANNUAL REPORT | 2019-03-06 |
| ANNUAL REPORT | 2018-02-26 |
| ANNUAL REPORT | 2017-03-01 |
| CORLCRACHG | 2016-08-23 |
| ANNUAL REPORT | 2016-03-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
