| Entity Name: | MANDEVILLE MANOR HEALTH SYSTEMS, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 17 Nov 2010 (14 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 08 Oct 2024 (4 months ago) |
| Document Number: | P10000094063 |
| FEI/EIN Number | 27-3939532 |
| Address: | 24 Old Kings Rd N., PALM COAST, FL 32137 |
| Mail Address: | 24 Old Kings Rd N., PALM COAST, FL 32137 |
| ZIP code: | 32137 |
| County: | Flagler |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | MANDEVILLE MANOR HEALTH SYSTEMS, INC, NEW YORK | 4273240 | NEW YORK |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427594944 | 2017-01-07 | 2017-01-07 | 40 PONCE DELEON DR, PALM COAST, FL, 321644910, US | 40 PONCE DELEON DR, PALM COAST, FL, 321644910, US | |||||||||||||||||||||||||
|
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| Phone | +1 386-586-5654 |
| Fax | 3865865440 |
Authorized person
| Name | MARGARET MCLARTY |
| Role | CHIEF FINANCIAL OFFICER |
| Phone | 3866794867 |
Taxonomy
| Taxonomy Code | 3104A0625X - Assisted Living Facility (Mental Illness) |
| License Number | 00000000 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 676845896 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LOGUIDICE, JOSEPH A | Agent | 1515 RIDGEWOOD AVENUE, SUITE A, HOLLY HILL, FL 32117 |
| Name | Role | Address |
|---|---|---|
| LEWIS, LESLIE O | President | 2728 Covered Bridge Rd, Merrick, NY 11566 |
| Name | Role | Address |
|---|---|---|
| LEWIS, LESLIE O | Chairman | 2728 Covered Bridge Rd, Merrick, NY 11566 |
| Name | Role | Address |
|---|---|---|
| MCLARTY, OLNEY G | Vice President | 42 CROSSTIE COURT, PALM COAST, FL 32137 |
| Name | Role | Address |
|---|---|---|
| MCLARTY, OLNEY G | Chief Executive Officer | 42 CROSSTIE COURT, PALM COAST, FL 32137 |
| Name | Role | Address |
|---|---|---|
| MCLARTY, OLNEY G | SECRETARY | 42 CROSSTIE COURT, PALM COAST, FL 32137 |
| MCLARTY LEWIS, MARGARET | SECRETARY | 5 WALTON PLACE, PALM COAST, FL 32164 |
| Name | Role | Address |
|---|---|---|
| MCLARTY LEWIS, MARGARET | Treasurer | 5 WALTON PLACE, PALM COAST, FL 32164 |
| Name | Role | Address |
|---|---|---|
| MCLARTY LEWIS, MARGARET | Chief Financial Officer | 5 WALTON PLACE, PALM COAST, FL 32164 |
| Name | Role | Address |
|---|---|---|
| DRUMMOND, ROSEMARY | Secretary | 10 Pritchard Dr, PALM COAST, FL 32164 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000023454 | PALM COAST ADULT DAYCARE | ACTIVE | 2016-03-03 | 2027-12-31 | No data | 24 OLD KINGS ROAD N, PALM COAST, FL, 32137 |
| G14000062774 | SYNERGY CLEANING SERVICE | EXPIRED | 2014-06-18 | 2019-12-31 | No data | 40 PONCE DELEON DRIVE, PALM COAST, FL, 32164 |
| G12000089990 | MANDEVILLE LIFE SKILLS CENTER | ACTIVE | 2012-09-13 | 2027-12-31 | No data | 24 OLD KINGS RD N SUITE A, PALM COAST, FL, 32137 |
| G12000030837 | MANDEVILLE MANOR GROUP HOMES | EXPIRED | 2012-03-29 | 2017-12-31 | No data | 40 PONCE DELEON DRIVE, PALM COAST, FL, 32164 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-10-08 | LOGUIDICE, JOSEPH A | No data |
| REINSTATEMENT | 2024-10-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| AMENDMENT | 2021-02-08 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-21 | 24 Old Kings Rd N., PALM COAST, FL 32137 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-01-09 | 24 Old Kings Rd N., PALM COAST, FL 32137 | No data |
| AMENDMENT | 2016-03-08 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-03-29 | 1515 RIDGEWOOD AVENUE, SUITE A, HOLLY HILL, FL 32117 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J23000407734 | ACTIVE | 22-039-D1 | LEON COUNTY | 2023-07-28 | 2028-09-06 | $29,648.58 | DFS DIVISION OF WORKERS COMPENSATION, 200 EAST GAINES STREET, TALLAHASSEE, FL 32399-4228 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-21 |
| REINSTATEMENT | 2024-10-08 |
| ANNUAL REPORT | 2023-01-09 |
| ANNUAL REPORT | 2022-01-16 |
| Amendment | 2021-02-08 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-01-21 |
| ANNUAL REPORT | 2019-01-09 |
| ANNUAL REPORT | 2018-05-19 |
| ANNUAL REPORT | 2017-07-04 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
