| Entity Name: | BRANDYWINE CONVALESCENT CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
BRANDYWINE CONVALESCENT CENTER, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 27 Mar 2000 (25 years ago) |
| Document Number: | P00000032167 |
| FEI/EIN Number |
593635204
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Mail Address: | PO Box 530787, DEBARY, FL, 32753, US |
| Address: | 1801 North Lake Mariam Drive, WINTER HAVEN, FL, 33884, US |
| ZIP code: | 33884 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518941582 | 2005-12-02 | 2020-10-08 | 1801 LAKE MARIAM DR, WINTER HAVEN, FL, 338840927, US | 1801 LAKE MARIAM DR, WINTER HAVEN, FL, 338840927, US | |||||||||||||||||||||||||
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| Phone | +1 863-293-1989 |
| Fax | 8632996427 |
Authorized person
| Name | VICTORIA LYNN SHARPLESS |
| Role | DIRECTOR OF ACCOUNTING |
| Phone | 3528746007 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF10600961 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025139900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HERZOG L P | President | PO Box 530787, DEBARY, FL, 32753 |
| Swain W S | Secretary | P.O. BOX 71030, MYRTLE BEACH, SC, 29572 |
| COGENCY GLOBAL INC. | Agent | - |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000059242 | BRANDYWYNE HEALTH CARE CENTER | EXPIRED | 2016-06-15 | 2021-12-31 | - | PO BOX 530206, DEBARY, FL, 32753 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-11 | 1801 North Lake Mariam Drive, WINTER HAVEN, FL 33884 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-27 | 1801 North Lake Mariam Drive, WINTER HAVEN, FL 33884 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-11 |
| ANNUAL REPORT | 2023-04-17 |
| ANNUAL REPORT | 2022-04-14 |
| ANNUAL REPORT | 2021-04-21 |
| ANNUAL REPORT | 2020-04-09 |
| ANNUAL REPORT | 2019-04-10 |
| ANNUAL REPORT | 2018-04-17 |
| ANNUAL REPORT | 2017-04-24 |
| ANNUAL REPORT | 2016-04-27 |
| Reg. Agent Change | 2016-01-29 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| - | IDV | VA248BO0085 | 2009-07-01 | - | - | |||||||||||||||||||||||
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| Obligated Amount | 0.00 |
| Potential Award Amount | 200000.00 |
Description
| Title | NURSING HOME SERVICES-THIS MODIFICATION IS FOR A MEDICAID RATE CHANGE |
| NAICS Code | 623110: NURSING CARE FACILITIES |
| Product and Service Codes | Q402: NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | BRANDYWINE CONVALESCENT CENTER INC |
| UEI | MH5BBSHMXRJ1 |
| Recipient Address | 1801 LAKE MARIAM DR, WINTER HAVEN, POLK, FLORIDA, 338841159, UNITED STATES |
| Unique Award Key | CONT_AWD_V673P5186FY09_3600_V673P5186_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Description
| Title | COMMUNITY NURSING HOME EXPENDITURE - FY08 |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | BRANDYWINE CONVALESCENT CENTER INC |
| UEI | MH5BBSHMXRJ1 |
| Legacy DUNS | 015000677 |
| Recipient Address | 1801 NORTH LAKE MARIAM DR, WINTER HAVEN, 338840927, UNITED STATES |
| Unique Award Key | CONT_AWD_V673P5186FY08_3600_V673P5186_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Description
| Title | COMMUNITY NURSING HOME EXPENDITURE - FY08 |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | BRANDYWINE CONVALESCENT CENTER INC |
| UEI | MH5BBSHMXRJ1 |
| Legacy DUNS | 015000677 |
| Recipient Address | 1801 NORTH LAKE MARIAM DR, WINTER HAVEN, 338840927, UNITED STATES |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 7892727005 | 2020-04-08 | 0455 | PPP | 1801 Lake Mariam Drive, WINTER HAVEN, FL, 33884 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Mar 2025
Sources: Florida Department of State
