| Entity Name: | REGENCY CARE OF BLOUNTSTOWN, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Apr 2010 (15 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 28 Oct 2019 (5 years ago) |
| Document Number: | M10000001571 |
| FEI/EIN Number | 264128207 |
| Address: | 74 8th St. SE, HICKORY, NC, 28602, US |
| Mail Address: | P.O. Box 1667, HICKORY, NC, 28603, US |
| Place of Formation: | VIRGINIA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871589093 | 2005-09-22 | 2015-04-22 | PO BOX 1667, HICKORY, NC, 286031667, 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 | 8508743798 |
Authorized person
| Name | MR. STEVEN D WOMACK |
| Role | MANAGING MEMBER |
| Phone | 8283815360 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1652096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE SNF LICENSE NUMBER |
| Number | SNF1652096 |
| State | FL |
| Issuer | MEDICAID |
| Number | 002298700 |
| State | FL |
| Issuer | STATE FACILITY MDS ID NUM |
| Number | 35960874 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Womack Steven | Manager | 74 8th St. SE, HICKORY, NC, 28602 |
| Woodward Jr. Melvin | Manager | P.O. Box 1667, HICKORY, NC, 28603 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000039961 | BLOUNTSTOWN HEALTH AND REHABILITATION CENTER | ACTIVE | 2010-05-06 | 2025-12-31 | No data | PO BOX 1667, HICKORY, NC, 28603, US |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-01-24 | 74 8th St. SE, Suite 225, Hickory, NC 28602 | No data |
| CHANGE OF MAILING ADDRESS | 2025-01-24 | 74 8th St. SE, Suite 225, Hickory, NC 28602 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-25 | 74 8th St. SE, Suite 225, HICKORY, NC 28602 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-09 | 74 8th St. SE, Suite 225, HICKORY, NC 28602 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-10-28 | CORPORATION SERVICE COMPANY | No data |
| LC STMNT OF RA/RO CHG | 2019-10-28 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-10-28 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-24 |
| ANNUAL REPORT | 2024-02-25 |
| ANNUAL REPORT | 2023-03-09 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-06-24 |
| CORLCRACHG | 2019-10-28 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-01-17 |
| ANNUAL REPORT | 2017-01-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
