| Entity Name: | CENTER FOR AGING AND REHABILITATION OF GREENVILLE, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 22 Mar 2021 (4 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 15 Nov 2024 (3 months ago) |
| Document Number: | N21000004859 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 2699 Stirling Road, Suite C403B, Ft Lauderdale, FL, 33312, US |
| Mail Address: | C/O TKP ACCOUNTING, 3550 POWERLINE ROAD, OAKLAND PARK, FL, 33309, US |
| ZIP code: | 33312 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043884596 | 2021-05-19 | 2021-06-24 | 3550 POWERLINE RD, OAKLAND PARK, FL, 333095917, US | 13455 W US 90, GREENVILLE, FL, 323314318, US | |||||||||||||||||||
|
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| Phone | +1 954-367-4597 |
Authorized person
| Name | MS. MARY ANNE WOOD |
| Role | MANAGER |
| Phone | 9543674597 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PENDING |
| State | FL |
| Name | Role | Address |
|---|---|---|
| kelly robert | Agent | 2699 Stirling Road, Suite C403B, Ft. Lauderdale, FL, 33312 |
| Name | Role | Address |
|---|---|---|
| BROCK ALAN | Director | 12460 CRABAPPLE RD STE 202-308, ALPHARETTA, GA, 30004 |
| BARRETT ALEX | Director | 1100 S. STRATFORD ROAD SUITE 400, WINSTON-SALEM, NC, 27104 |
| HOGE BRETT | Director | 1100 S. STRATFORD RD STE 400, WINSTON-SALEM, NC, 27104 |
| kelly robert | Director | 2699 Stirling Road, Suite C403B, Ft. Lauderdale, FL, 33312 |
| Name | Role | Address |
|---|---|---|
| kelly robert | Secretary | 2699 Stirling Road, Suite C403B, Ft. Lauderdale, FL, 33312 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000067772 | GREENVILLE CARE CENTER | ACTIVE | 2021-05-18 | 2026-12-31 | No data | 3550 POWERLINE ROAD, C/O TKP ACCOUNTING, OAKLAND PARK, FL, 33309 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-11-15 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-12 | 2699 Stirling Road, Suite C403B, Ft Lauderdale, FL 33312 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-09-02 | kelly, robert | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-09-02 | 2699 Stirling Road, Suite C403B, Ft. Lauderdale, FL 33312 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-01 | 2699 Stirling Road, Suite C403B, Ft Lauderdale, FL 33312 | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-11-15 |
| ANNUAL REPORT | 2023-04-12 |
| AMENDED ANNUAL REPORT | 2022-09-02 |
| ANNUAL REPORT | 2022-02-01 |
| Domestic Non-Profit | 2021-03-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
