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THE PAVILION AT CRESCENT LAKE FOR NURSING AND REHABILITATION, LLC - Florida Company Profile

Company Details

Entity Name: THE PAVILION AT CRESCENT LAKE FOR NURSING AND REHABILITATION, 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: 18 Mar 2021 (4 years ago)
Document Number: M21000003141
FEI/EIN Number 86-2465234

Federal Employer Identification (FEI) Number assigned by the IRS.

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

Key Officers & Management

Name Role Address
MOERMAN RAFAEL A Manager 1 VALLEY GREENS DRIVE, VALLEY STREAM, NY, 11581
Pavilion at Crescent Lake Agent 100 N. Lake St, Crescent City, FL, 32112

National Provider Identifier

NPI Number:
1386229250
Certification Date:
2021-03-12

Authorized Person:

Name:
RAFAEL A MOERMAN
Role:
MANAGING MEMBER
Phone:

Taxonomy:

Selected Taxonomy:
314000000X - Skilled Nursing Facility
Is Primary:
Yes

Contacts:

Fictitious Names

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 - 100 N LAKE ST, CRESCENT CITY, FL, 32112

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2022-03-03 Pavilion at Crescent Lake -
REGISTERED AGENT ADDRESS CHANGED 2022-03-03 100 N. Lake St, Crescent City, FL 32112 -

Documents

Name Date
ANNUAL REPORT 2025-02-05
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 Jun 2025

Sources: Florida Department of State