| Entity Name: | CARLTON SHORES NH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 29 Jan 2010 (15 years ago) |
| Document Number: | M10000000412 |
| FEI/EIN Number |
271842333
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1350 S NOVA ROAD, DAYTONA BEACH, FL, 32114-5812 |
| Mail Address: | 1350 South Nova Road, 4042 PARK OAKS BLVD., SUITE 300, Daytona Beach, FL, 32114, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588986368 | 2010-02-22 | 2011-06-20 | 1350 S NOVA RD, DAYTONA BEACH, FL, 321145812, US | 1350 S NOVA RD, DAYTONA BEACH, FL, 321145812, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 386-258-5544 |
| Fax | 3862555623 |
Authorized person
| Name | MR. WILLIAM P MANDO |
| Role | CFO |
| Phone | 8136359500 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | 6110 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 002213800 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME) |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002213800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NH Operator Holdings II LLC | Auth | 400 Rella blvd, Montebello, NY, 10901 |
| CORPORATION SERVICE COMPANY | Agent | - |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000016910 | CARLTON SHORES HEALTH AND REHABILITATION CENTER | ACTIVE | 2010-02-22 | 2025-12-31 | - | 4042 PARK OAKS BLVD, 4042 PARK OAKS BLVD., SUITE 300, LAKELAND, FL, 33810 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-03-04 | 1350 S NOVA ROAD, DAYTONA BEACH, FL 32114-5812 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2011-04-22 | 1350 S NOVA ROAD, DAYTONA BEACH, FL 32114-5812 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-03-14 |
| AMENDED ANNUAL REPORT | 2022-06-23 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-03-04 |
| ANNUAL REPORT | 2020-04-07 |
| ANNUAL REPORT | 2019-03-06 |
| ANNUAL REPORT | 2018-03-21 |
| ANNUAL REPORT | 2017-03-17 |
| ANNUAL REPORT | 2016-04-25 |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 345856363 | 0419700 | 2022-03-24 | 1350 S NOVA RD., DAYTONA BEACH, FL, 32114 | |||||||||||||||||||||
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| Type | Complaint |
| Activity Nr | 1549202 |
| Health | Yes |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 3315598600 | 2021-03-16 | 0491 | PPP | 1350 S Nova Rd, Daytona Beach, FL, 32114-5812 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 Mar 2025
Sources: Florida Department of State
