| Entity Name: | THE PAVILION AT CRESCENT LAKE FOR NURSING AND REHABILITATION, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Mar 2021 (4 years ago) |
| Document Number: | M21000003141 |
| FEI/EIN Number | 86-2465234 |
| Address: | 100 N LAKE ST, CRESCENT CITY, FL, 32112, US |
| Mail Address: | 1 VALLEY GREENS DRIVE, VALLEY STREAM, NY, 11581, US |
| ZIP code: | 32112 |
| County: | Putnam |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386229250 | 2021-03-12 | 2021-03-12 | 1 VALLEY GREENS DR, VALLEY STREAM, NY, 115813634, US | 100 N LAKE ST, CRESCENT CITY, FL, 321122620, US | |||||||||||||
|
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| Phone | +1 516-865-1500 |
Authorized person
| Name | RAFAEL A MOERMAN |
| Role | MANAGING MEMBER |
| Phone | 5168651500 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Pavilion at Crescent Lake | Agent | 100 N. Lake St, Crescent City, FL, 32112 |
| Name | Role | Address |
|---|---|---|
| MOERMAN RAFAEL A | Manager | 1 VALLEY GREENS DRIVE, VALLEY STREAM, NY, 11581 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000040265 | THE PAVILION AT CRESCENT LAKE | ACTIVE | 2021-03-24 | 2026-12-31 | No data | 100 N LAKE ST, CRESCENT CITY, FL, 32112 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-03-03 | Pavilion at Crescent Lake | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-03 | 100 N. Lake St, Crescent City, FL 32112 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-03-03 |
| Foreign Limited | 2021-03-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
