| Entity Name: | BLOUNTSTOWN HEALTH AND REHABILITATION CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 22 Dec 2008 (16 years ago) |
| Date of dissolution: | 09 Nov 2009 (15 years ago) |
| Last Event: | LC WITHDRAWAL |
| Event Date Filed: | 09 Nov 2009 (15 years ago) |
| Document Number: | M08000005510 |
| Address: | 1978 8TH AVE NW, HICKORY, NC, 28601 |
| Mail Address: | 1978 8TH AVE NW, HICKORY, NC, 28601 |
| Place of Formation: | VIRGINIA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033360862 | 2008-10-10 | 2008-10-10 | PO BOX 3343, HICKORY, NC, 286033343, US | 16690 SW CHIPOLA RD, BLOUNTSTOWN, FL, 324241953, US | |||||||||||||||||||||||
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| Phone | +1 828-324-8898 |
| Fax | 8283229598 |
| Phone | +1 850-674-4311 |
| Fax | 8506743798 |
Authorized person
| Name | MR. STEVEN D WOMACK |
| Role | MANAGER |
| Phone | 8283248898 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1652096 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BLOUNTSTOWN HEALTH AND REHAB 401K PLAN | 2023 | 873508681 | 2024-07-01 | BLOUNTSTOWN HEALTH AND REHABILITATION CENTER | 101 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-01 |
| Name of individual signing | ANGELA STIDAM |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2024-07-01 |
| Name of individual signing | ANGELA STIDAM |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| CAPITOL CORPORATE SERVICES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| DOMINION HEALTH CARE OPERATOR, LLC | Manager | 1978 8TH AVE NW, HICKORY, NC, 28601 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-08-01 | 1978 8TH AVE NW, HICKORY, NC 28601 | No data |
| CHANGE OF MAILING ADDRESS | 2025-08-01 | 1978 8TH AVE NW, HICKORY, NC 28601 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-08-01 | 1978 8TH AVE NW, HICKORY, NC 28601 | No data |
| CHANGE OF MAILING ADDRESS | 2024-08-01 | 1978 8TH AVE NW, HICKORY, NC 28601 | No data |
| LC WITHDRAWAL | 2009-11-09 | No data | No data |
| REVOKED FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| Name | Date |
|---|---|
| LC Withdrawal | 2009-11-09 |
| Foreign Limited | 2008-12-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
