| Entity Name: | WEST JAX SKILLED NURSING INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 02 Feb 2016 (9 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | P16000010909 |
| Address: | 100 CYPRESS LAGOON COURT, PONTE VEDRA BEACH, FL, 32082, US |
| Mail Address: | 100 CYPRESS LAGOON COURT, PONTE VEDRA BEACH, FL, 32082, US |
| ZIP code: | 32082 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063898864 | 2015-08-04 | 2015-08-04 | 100 CYPRESS LAGOON CT, PONTE VEDRA BEACH, FL, 320822106, US | 100 CYPRESS LAGOON CT, PONTE VEDRA BEACH, FL, 320822106, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 904-783-2405 |
| Fax | 9047864981 |
Authorized person
| Name | DR. MICHAEL VICTOR SHARPE |
| Role | SUPERVISOR |
| Phone | 9047832405 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 1750382669 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 1285048280 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 620455400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHARPE MICHAEL V | Agent | 100 CYPRESS LAGOON COURT, PONTE VEDRA BEACH, FL, 32082 |
| Name | Role | Address |
|---|---|---|
| SHARPE MICHAEL V | Director | 100 CYPRESS LAGOON COURT, PONTE VEDRA BEACH, FL, 32082 |
| Name | Role | Address |
|---|---|---|
| SHARPE MICHAEL V | President | 100 CYPRESS LAGOON COURT, PONTE VEDRA BEACH, FL, 32082 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| Name | Date |
|---|---|
| Domestic Profit | 2016-02-02 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
