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BLOUNTSTOWN FL OPERATOR LLC - Florida Company Profile

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Company Details

Entity Name: BLOUNTSTOWN FL OPERATOR 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: 12 Nov 2021 (4 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 04 Dec 2024 (7 months ago)
Document Number: M21000015178
FEI/EIN Number 87-3508681

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

Address: 1044 BROADWAY, WOODMERE, NY, 11598, US
Mail Address: 300 Provider Court, Richmond, KY, 40475, US
Place of Formation: DELAWARE

Key Officers & Management

Name Role Address
VARGHESE MATHEW Manager 57 BANK STREET, WHITE PLAINS, NU, 10606
Medlin Crystal Agent 1200 S PINE ISLAND ROAD, PLANTATION, FL, 33324

National Provider Identifier

NPI Number:
1003569385
Certification Date:
2022-01-27

Authorized Person:

Name:
ROBERT KOLMAN
Role:
OPERATOR
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
G21000165875 BLOUNTSTOWN HEALTH AND REHABILITATION CENTER ACTIVE 2021-12-16 2026-12-31 - 1044 BROADWAY, WOODMERE, NY, 11596
G21000166537 BLOUNTSTOWN HEALTH AND REHABILITATION CENTER ACTIVE 2021-12-15 2026-12-31 - 1044 BROADWAY, WOODMERE, NY, 11598
G21000166156 BLOUNTSTOWN HEALTH AND REHABILITATION CENTER ACTIVE 2021-12-14 2026-12-31 - 1044 BROADWAY, WOODMERE, NY, 11598
G21000166268 BLOUNTSTOWN HEALTH AND REHABILITATION CENTER ACTIVE 2021-12-14 2026-12-31 - 1044 BROADWAY, WOODMERE, NY, 11598

Events

Event Type Filed Date Value Description
REINSTATEMENT 2024-12-04 - -
REGISTERED AGENT NAME CHANGED 2024-12-04 Medlin, Crystal -
REVOKED FOR ANNUAL REPORT 2024-09-27 - -
CHANGE OF MAILING ADDRESS 2022-08-15 1044 BROADWAY, WOODMERE, NY 11598 -
REGISTERED AGENT ADDRESS CHANGED 2022-01-20 1200 S PINE ISLAND ROAD, PLANTATION, FL 33324 -

Documents

Name Date
REINSTATEMENT 2024-12-04
ANNUAL REPORT 2023-04-05
ANNUAL REPORT 2022-08-15
Foreign Limited 2021-11-12

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Date of last update: 03 Jun 2025

Sources: Florida Department of State