| Entity Name: | SILVER LAKE VILLAGE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 May 2019 (6 years ago) |
| Document Number: | P19000037733 |
| FEI/EIN Number | 83-4683019 |
| Address: | 34601 RADIO RD, LEESBURG, FL, 34788, US |
| Mail Address: | 3022 Castelli Blvd, Mount Dora, FL, 32757, US |
| ZIP code: | 34788 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952937112 | 2020-03-19 | 2020-03-19 | 33857 TERRAGONA DR, SORRENTO, FL, 327766918, US | 34601 RADIO RD, LEESBURG, FL, 347883301, US | |||||||||||||||||||
|
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| Phone | +1 503-833-2814 |
Authorized person
| Name | SAMUEL BONGIOVANNI |
| Role | PRESIDENT |
| Phone | 5038332814 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | NONE |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BONGIOVANNI SAMUEL | Agent | 3022 Castelli Blvd, Mount Dora, FL, 32757 |
| Name | Role | Address |
|---|---|---|
| BONGIOVANNI SAMUEL | President | 34601 RADIO RD, LEESBURG, FL, 34788 |
| Name | Role | Address |
|---|---|---|
| BHAGWANSINGH MARTHA | Vice President | 34601 RADIO RD, LEESBURG, FL, 34788 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000055934 | SILVER LAKE VILLAGE | EXPIRED | 2019-05-08 | 2024-12-31 | No data | 1069 NW 18TH AVE,, BOCA RATON, FL, 33486--141 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-04-10 | 34601 RADIO RD, LEESBURG, FL 34788 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-10 | 3022 Castelli Blvd, Mount Dora, FL 32757 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-09-11 | BONGIOVANNI, SAMUEL | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-26 |
| ANNUAL REPORT | 2023-04-10 |
| ANNUAL REPORT | 2022-05-01 |
| ANNUAL REPORT | 2021-04-09 |
| ANNUAL REPORT | 2020-03-20 |
| Reg. Agent Change | 2019-09-11 |
| Domestic Profit | 2019-05-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
