| Entity Name: | BROOKS SKILLED NURSING FACILITY A, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 18 Mar 2010 (15 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 23 May 2011 (14 years ago) |
| Document Number: | N10000002821 |
| FEI/EIN Number | 272153586 |
| Address: | 3599 UNIVERSITY BLVD. S, JACKSONVILLE, FL, 32216 |
| Mail Address: | 3599 UNIVERSITY BLVD. S, JACKSONVILLE, FL, 32216 |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669831079 | 2016-02-12 | 2024-09-20 | 3599 UNIVERSITY BLVD S, ATTN: MANAGED CARE, JACKSONVILLE, FL, 322164252, US | 6210 BEACH BLVD, JACKSONVILLE, FL, 32216, US | |||||||||||||||||||||||
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| Phone | +1 904-345-7291 |
| Fax | 9043457284 |
| Phone | +1 904-345-8101 |
| Fax | 9043458108 |
Authorized person
| Name | KELLI CAMERON |
| Role | DIRECTOR OF MANAGED CARE |
| Phone | 9043457158 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1149095 |
| State | FL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| URS AGENTS, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| BAER DOUGLAS M | Director | 3599 UNIVERSITY BLVD. S, JACKSONVILLE, FL, 32216 |
| Serkin Howard C | Director | 3599 UNIVERSITY BLVD. S, JACKSONVILLE, FL, 32216 |
| Mann Eric | Director | 3599 UNIVERSITY BLVD. S, JACKSONVILLE, FL, 32216 |
| Tabor J B | Director | 3599 UNIVERSITY BLVD. S, JACKSONVILLE, FL, 32216 |
| Name | Role | Address |
|---|---|---|
| BAER DOUGLAS M | Chairman | 3599 UNIVERSITY BLVD. S, JACKSONVILLE, FL, 32216 |
| Name | Role | Address |
|---|---|---|
| DERIENZO VICTOR | Vice President | 3599 UNIVERSITY BLVD. S, JACKSONVILLE, FL, 32216 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000020310 | UNIVERSITY CROSSING | ACTIVE | 2016-02-25 | 2026-12-31 | No data | 3599 UNIVERSITY BLVD., S, JACKSONVILLE, FL, 32216 |
| G16000020308 | UNIVERSITY CROSSING SKILLED NURSING | ACTIVE | 2016-02-25 | 2026-12-31 | No data | 3599 UNIVERSITY BLVD S, JACKSONVILLE, FL, 32216 |
| G16000020309 | BROOKS UNIVERSITY CROSSING | ACTIVE | 2016-02-25 | 2026-12-31 | No data | 3599 UNIVERSITY BLVD.S, JACKSONVILLE, FL, 32216 |
| G13000027006 | BARTRAM CROSSING | ACTIVE | 2013-03-19 | 2028-12-31 | No data | 3599 UNIVERSITY BLVD., S, 3RD FLOOR FINANCE DEPT., JACKSONVILLE, FL, 32216 |
| G13000010134 | THE GREEN HOUSE RESIDENCES | ACTIVE | 2013-01-29 | 2028-12-31 | No data | 3599 UNIVERSITY BLVD., S, 3RD FLOOR FINANCE DEPT., JACKSONVILLE, FL, 32216 |
| G13000010140 | BARTRAM SENIOR SERVICES | EXPIRED | 2013-01-29 | 2018-12-31 | No data | 3599 UNIVERSITY BLVD., S, JACKSONVILLE, FL, 32216 |
| G13000010118 | BROOKS REHABILITATION AT BARTRAM PARK | EXPIRED | 2013-01-29 | 2018-12-31 | No data | 3599 UNIVERSITY BLVD., S, JACKSONVILLE, FL, 32216 |
| G13000010124 | BARTRAM CROSSING SKILLED NURSING | ACTIVE | 2013-01-29 | 2028-12-31 | No data | 3599 UNIVERSITY BLVD., S, 3RD FLOOR FINANCE DEPT., JACKSONVILLE, FL, 32216 |
| G13000010128 | BARTRAM LAKES ASSISTED LIVING | ACTIVE | 2013-01-29 | 2028-12-31 | No data | 3599 UNIVERSITY BLVD., S, 3RD FLOOR FINANCE DEPT., JACKSONVILLE, FL, 32216 |
| G10000044414 | ST. JOHNS HEALTH CARE CENTER | EXPIRED | 2010-05-20 | 2015-12-31 | No data | 189 SAN MARCO AVENUE, ST. AUGUSTINE, FL, 32084 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2020-08-19 | URS AGENTS, LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-08-19 | 3458 LAKESHORE DRIVE, TALLAHASSEE, FL 32312 | No data |
| AMENDMENT | 2011-05-23 | No data | No data |
| AMENDMENT | 2010-08-16 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-03-22 |
| Reg. Agent Change | 2020-08-19 |
| AMENDED ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2020-04-02 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-24 |
| Reg. Agent Change | 2018-02-07 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DELIVERY ORDER | AWARD | 36C24824N0636 | 2024-06-01 | 2025-05-31 | 2025-05-31 | |||||||||||||||||||||||||
|
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| Obligated Amount | 660000.00 |
| Current Award Amount | 660000.00 |
| Potential Award Amount | 660000.00 |
Description
| Title | EO14042 - 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 | BROOKS SKILLED NURSING FACILITY A, INC. |
| UEI | HU7PKF21KMQ2 |
| Recipient Address | UNITED STATES, 6209 BROOKS BARTRAM DR BLDG 100, JACKSONVILLE, DUVAL, FLORIDA, 322585602 |
| Unique Award Key | CONT_IDV_36C24821D0066_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Award Amounts
| Obligated Amount | 0.00 |
| Potential Award Amount | 3300000.00 |
Description
| Title | EO14042 - 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 | BROOKS SKILLED NURSING FACILITY A, INC. |
| UEI | HU7PKF21KMQ2 |
| Recipient Address | UNITED STATES, 6209 BROOKS BARTRAM DR BLDG 100, JACKSONVILLE, DUVAL, FLORIDA, 322585602 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
