| Entity Name: | LADY LAKE SPECIALTY CARE CENTER AND REHAB LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Mar 2022 (3 years ago) |
| Document Number: | M22000004541 |
| FEI/EIN Number | 88-1251152 |
| Mail Address: | 4417 13th Street, Saint Cloud, FL, 34769, US |
| Address: | 630 Griffin Avenue,, Lady Lake, FL, 32159, US |
| ZIP code: | 32159 |
| County: | Lake |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013666551 | 2022-03-22 | 2022-03-22 | 630 GRIFFIN AVE, LADY LAKE, FL, 321598101, US | 630 GRIFFIN AVE, LADY LAKE, FL, 321598101, US | |||||||||||||
|
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| Phone | +1 352-750-6619 |
Authorized person
| Name | MOSHE SCHEINER |
| Role | AUTHORIZED OFFICIAL |
| Phone | 8454906060 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
| Name | Role |
|---|---|
| VSTATE FILINGS LLC | Agent |
| Name | Role | Address |
|---|---|---|
| Manela Robert | Auth | 630 Griffin Avenue,, Lady Lake, FL, 32159 |
| Milburn Mindy | Auth | 630 Griffin Avenue,, Lady Lake, FL, 32159 |
| Oliver Tonya | Auth | 400 RELLA BLVD, MONTEBELLO, NY, 10901 |
| Name | Role | Address |
|---|---|---|
| LADY LAKE SNF HOLDCO LLC | Managing Member | 400 RELLA BLVD, MONTEBELLO, NY, 10901 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000043757 | LADY LAKE SPECIALTY CARE CENTER AND REHAB | ACTIVE | 2022-04-06 | 2027-12-31 | No data | 4417 13TH STREET, STE 180, SAINT CLOUD, FL, 34769 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-08 | 7064 NORTHWEST 49TH STREET, LAUDERHILL, FL 33319 | No data |
| CHANGE OF MAILING ADDRESS | 2024-09-12 | 630 Griffin Avenue,, Lady Lake, FL 32159 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-04 | 630 Griffin Avenue,, Lady Lake, FL 32159 | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-09-12 |
| AMENDED ANNUAL REPORT | 2024-07-25 |
| ANNUAL REPORT | 2024-01-31 |
| AMENDED ANNUAL REPORT | 2023-12-20 |
| ANNUAL REPORT | 2023-04-04 |
| Foreign Limited | 2022-03-25 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No data | IDV | 36C24824D0079 | 2024-06-15 | No data | No data | |||||||||||||||||||||||
|
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| Obligated Amount | 0.00 |
| Potential Award Amount | 3200000.00 |
Description
| Title | ESTIMATED NURSING HOME SERVICES |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES |
Recipient Details
| Recipient | LADY LAKE SPECIALTY CARE CENTER AND REHAB LLC |
| UEI | MYA3FRJRT1E5 |
| Recipient Address | UNITED STATES, 630 GRIFFIN AVE, LADY LAKE, LAKE, FLORIDA, 321598101 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
