| Entity Name: | BLOUNTSTOWN FL OPERATOR LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Active |
| Date Filed: | 12 Nov 2021 (3 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 04 Dec 2024 (2 months ago) |
| Document Number: | M21000015178 |
| FEI/EIN Number | 87-3508681 |
| Address: | 1044 BROADWAY, WOODMERE, NY 11598 |
| Mail Address: | 300 Provider Court, Richmond, KY 40475 |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003569385 | 2022-01-27 | 2022-01-27 | 16690 SW CHIPOLA RD, BLOUNTSTOWN, FL, 324241953, US | 16690 SW CHIPOLA RD, BLOUNTSTOWN, FL, 324241953, US | |||||||||||||
|
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| Phone | +1 917-295-1882 |
Authorized person
| Name | ROBERT KOLMAN |
| Role | OPERATOR |
| Phone | 9172951882 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Medlin, Crystal | Agent | 1200 S PINE ISLAND ROAD, PLANTATION, FL 33324 |
| Name | Role | Address |
|---|---|---|
| VARGHESE, MATHEW | Manager | 57 BANK STREET, WHITE PLAINS, NU 10606 |
| 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 | No data | 1044 BROADWAY, WOODMERE, NY, 11596 |
| G21000166537 | BLOUNTSTOWN HEALTH AND REHABILITATION CENTER | ACTIVE | 2021-12-15 | 2026-12-31 | No data | 1044 BROADWAY, WOODMERE, NY, 11598 |
| G21000166156 | BLOUNTSTOWN HEALTH AND REHABILITATION CENTER | ACTIVE | 2021-12-14 | 2026-12-31 | No data | 1044 BROADWAY, WOODMERE, NY, 11598 |
| G21000166268 | BLOUNTSTOWN HEALTH AND REHABILITATION CENTER | ACTIVE | 2021-12-14 | 2026-12-31 | No data | 1044 BROADWAY, WOODMERE, NY, 11598 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-12-04 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2024-12-04 | Medlin, Crystal | No data |
| REVOKED FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2022-08-15 | 1044 BROADWAY, WOODMERE, NY 11598 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-20 | 1200 S PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-12-04 |
| ANNUAL REPORT | 2023-04-05 |
| ANNUAL REPORT | 2022-08-15 |
| Foreign Limited | 2021-11-12 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
