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LADY LAKE SPECIALTY CARE CENTER AND REHAB LLC - Florida Company Profile

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Company Details

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
Address: 630 Griffin Avenue,, Lady Lake, FL, 32159, US
Mail Address: 630 Griffin Ave, Lady Lake, FL, 32159-8101, US
ZIP code: 32159
City: Lady Lake
County: Lake
Place of Formation: DELAWARE

Key Officers & Management

Name Role Address
LADY LAKE SNF HOLDCO LLC Managing Member 400 RELLA BLVD, MONTEBELLO, NY, 10901
Oliver Tonya Auth 400 RELLA BLVD, MONTEBELLO, NY, 10901
- Agent -

U.S. Small Business Administration Profile

Phone Number:
E-mail Address:
Contact Person:
TANIA ABRAHAM
Ownership and Self-Certifications:
Self-Certified Small Disadvantaged Business
User ID:
P3230231

Commercial and government entity program

CAGE number:
9SV11
Status:
Active
Type:
Non-Manufacturer
CAGE Update Date:
2024-11-19
CAGE Expiration:
2029-11-19
SAM Expiration:
2025-11-18

Contact Information

POC:
TANIA ABRAHAM

National Provider Identifier

NPI Number:
1013666551
Certification Date:
2022-03-22

Authorized Person:

Name:
MOSHE SCHEINER
Role:
AUTHORIZED OFFICIAL
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
G22000043757 LADY LAKE SPECIALTY CARE CENTER AND REHAB ACTIVE 2022-04-06 2027-12-31 - 4417 13TH STREET, STE 180, SAINT CLOUD, FL, 34769

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2025-01-08 7064 NORTHWEST 49TH STREET, LAUDERHILL, FL 33319 -
CHANGE OF MAILING ADDRESS 2024-09-12 630 Griffin Avenue,, Lady Lake, FL 32159 -
CHANGE OF PRINCIPAL ADDRESS 2023-04-04 630 Griffin Avenue,, Lady Lake, FL 32159 -

Documents

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

USAspending Awards / Contracts

Procurement Instrument Identifier:
36C24825N0651
Award Or Idv Flag:
AWARD
Award Type:
DELIVERY ORDER
Action Obligation:
640000.00
Base And Exercised Options Value:
640000.00
Base And All Options Value:
640000.00
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2025-06-15
Description:
NURSING HOME SERVICES
Naics Code:
623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product Or Service Code:
Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES
Procurement Instrument Identifier:
36C24824D0079
Award Or Idv Flag:
IDV
Action Obligation:
0.00
Base And All Options Value:
0.00
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2024-06-15
Description:
ESTIMATED NURSING HOME SERVICES
Naics Code:
623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product Or Service Code:
Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES

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Date of last update: 01 Aug 2025

Sources: Florida Department of State