| Entity Name: | LAKESIDE TLF, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 29 Oct 2020 (4 years ago) |
| Document Number: | M20000009767 |
| FEI/EIN Number | 853764955 |
| Address: | 1962 VANDOLAH RD., WAUCHULA, FL, 33873, US |
| Mail Address: | 1962 VANDOLAH RD., WAUCHULA, FL, 33873, US |
| ZIP code: | 33873 |
| County: | Hardee |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134722820 | 2020-11-17 | 2020-11-17 | 10866 WASHINGTON BLVD STE 42, CULVER CITY, CA, 902323610, US | 1962 VANDOLAH RD, WAUCHULA, FL, 338738726, US | |||||||||||||||||||||||||||
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| Phone | +1 213-986-8416 |
| Phone | +1 800-697-5390 |
Authorized person
| Name | DR. MANEESH BANSAL |
| Role | COO |
| Phone | 8006975390 |
Taxonomy
| Taxonomy Code | 283X00000X - Rehabilitation Hospital |
| Is Primary | Yes |
| Taxonomy Code | 320600000X - Intellectual and/or Developmental Disabilities Residential Treatment Facility |
| Is Primary | No |
| Taxonomy Code | 320700000X - Physical Disabilities Residential Treatment Facility |
| Is Primary | No |
| Taxonomy Code | 322D00000X - Emotionally Disturbed Childrens' Residential Treatment Facility |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Choquette Elizabeth AMBR | Agent | 1962 VANDOLAH RD., WAUCHULA, FL, 33873 |
| Name | Role |
|---|---|
| LAKESIDE OPCO, INC. | Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000146414 | LAKESIDE NEUROLOGIC | ACTIVE | 2020-11-13 | 2025-12-31 | No data | 1962 VANDOLAH ROAD, WAUCHULA, FL, 33873 |
| G19000108473 | LAKESIDE NEUROLOGIC | ACTIVE | 2019-10-04 | 2029-12-31 | No data | 1962 VANDOLAH ROAD, WAUCHULA, FL, 33873 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-05 | 1962 VANDOLAH RD., PO Box 1348, WAUCHULA, FL 33873 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-05 | 1962 VANDOLAH RD., PO Box 1348, WAUCHULA, FL 33873 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-05 | 1962 VANDOLAH RD., PO Box 1348, WAUCHULA, FL 33873 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-03-15 | Choquette, Elizabeth AMBR | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-03-05 |
| ANNUAL REPORT | 2024-02-16 |
| ANNUAL REPORT | 2023-03-15 |
| ANNUAL REPORT | 2022-02-23 |
| ANNUAL REPORT | 2021-03-25 |
| Foreign Limited | 2020-10-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
