| Entity Name: | LAKE GIBSON VILLAGE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 02 Mar 2017 (8 years ago) |
| Date of dissolution: | 27 Sep 2024 (4 months ago) |
| Last Event: | REVOKED FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (4 months ago) |
| Document Number: | M17000001885 |
| FEI/EIN Number | 82-0590161 |
| Address: | 444 Seabreeze Blvd, Suite 200, Daytona Beach, FL 32118 |
| Mail Address: | 444 Seabreeze Blvd, Suite 200, Daytona Beach, FL 32118 |
| ZIP code: | 32118 |
| County: | Volusia |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427547025 | 2018-05-09 | 2018-05-09 | 771 CARPENTERS WAY, LAKELAND, FL, 338093922, US | 771 CARPENTERS WAY, LAKELAND, FL, 338093922, US | |||||||||||||||||
|
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| Phone | +1 850-766-3712 |
Authorized person
| Name | RENEE TUCKER |
| Role | CHIEF EXECUTIVE OFFICER |
| Phone | 8507663712 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | 13081 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ANDERSON, DAVID C | Agent | 444 Seabreeze Blvd., 200, DAYTONA BEACH, FL 32118 |
| Name | Role | Address |
|---|---|---|
| COOK, SANDRA J | Manager | 14 ELIZABETH LANE, DAYTONA BEACH, FL 32118 |
| Anderson, David C | Manager | 444 Seabreeze Blvd, Suite 200 Daytona Beach, FL 32118 |
| GDAF MANAGEMENT, LLC | Manager | No data |
| Name | Role | Address |
|---|---|---|
| Dyer, Eileen Tucker | Chief Executive Officer | 21 Ocean Ridge Blvd S., Palm Coast, FL 32137 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000056446 | LAKE GIBSON VILLAGE | EXPIRED | 2017-05-23 | 2022-12-31 | No data | 771 CARPENTERS WAY, LAKELAND, FL, 33809 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REVOKED FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-11-07 | ANDERSON, DAVID C | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-22 | 444 Seabreeze Blvd, Suite 200, Daytona Beach, FL 32118 | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-22 | 444 Seabreeze Blvd, Suite 200, Daytona Beach, FL 32118 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-02-20 | 444 Seabreeze Blvd., 200, DAYTONA BEACH, FL 32118 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-01-24 |
| AMENDED ANNUAL REPORT | 2022-11-07 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-02-20 |
| ANNUAL REPORT | 2018-07-20 |
| Foreign Limited | 2017-03-02 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
