| Entity Name: | SOUTHERN PINES NURSING CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Active |
| Date Filed: | 07 Jul 2022 (3 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 18 Oct 2023 (a year ago) |
| Document Number: | M22000010484 |
| FEI/EIN Number | 88-3151651 |
| Address: | 6140 CONGRESS ST, NEW PORT RICHEY, FL 34653 |
| Mail Address: | 6140 CONGRESS ST, NEW PORT RICHEY, FL 34653 |
| ZIP code: | 34653 |
| County: | Pasco |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033844378 | 2022-07-20 | 2022-07-20 | 6140 CONGRESS ST, NEW PORT RICHEY, FL, 346533909, US | 6140 CONGRESS ST, NEW PORT RICHEY, FL, 346533909, US | |||||||||||||||||||||
|
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| Phone | +1 727-842-8402 |
| Fax | 7278418060 |
Authorized person
| Name | MATHEW VARGHESE |
| Role | MEMBER |
| Phone | 9178173530 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | LICENSE |
| Number | 15060961 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Klein, Yoel | Agent | 115 NORTH CALHOUN ST., SUITE 4, TALLAHASSEE, FL 32301 |
| Name | Role | Address |
|---|---|---|
| THACKER, TRICIA | Authorized Person | 10150 HIGHLAND MANOR DR., #300 TAMPA, FL 33610 |
| ASTON HEALTHCARE LLC | Authorized Person | No data |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000094141 | SOUTHERN PINES NURSING CENTER | ACTIVE | 2022-08-10 | 2027-12-31 | No data | 6140 CONGRESS ST, NEW PORT RICHEY, FL, 34653 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2023-10-18 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-10-18 | Klein, Yoel | No data |
| REVOKED FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| REINSTATEMENT | 2023-10-18 |
| Foreign Limited | 2022-07-07 |
Date of last update: 12 Jan 2025
Sources: Florida Department of State
