| Entity Name: | WOODLANDS EXTENDED CARE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 16 Oct 1995 (29 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | P95000080438 |
| FEI/EIN Number | 593347308 |
| Address: | 5151 Church Street, Skokie, IL, 60077, US |
| Mail Address: | 5151 Church Street, Skokie, IL, 60077, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851360242 | 2006-03-16 | 2012-04-25 | 120 W CHIPOLA AVE, DELAND, FL, 327207704, US | 120 W CHIPOLA AVE, DELAND, FL, 327207704, US | |||||||||||||||||||||||||
|
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| Phone | +1 386-738-3433 |
| Fax | 3867408308 |
Authorized person
| Name | MS. DONNA J MARSH |
| Role | BOOKKEEPER |
| Phone | 3862551054 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 16490961 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 021263600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Bengio Jacob | Agent | 390 NE 135th Street Miami, FL 33161, Miami, FL, 33161 |
| Name | Role | Address |
|---|---|---|
| ESFORMES Morris | President | 5151 Church Street, Skokie, IL, 60077 |
| Name | Role | Address |
|---|---|---|
| ESFORMES Morris | Director | 5151 Church Street, Skokie, IL, 60077 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09055900474 | WOODLAND TERRACE EXTENDED CARE CENTER | EXPIRED | 2009-02-24 | 2014-12-31 | No data | 120 CHIPOLA AVENUE, DELAND, FL, 32730 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-03-25 | 390 NE 135th Street Miami, FL 33161, Miami, FL 33161 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-29 | 5151 Church Street, Suite H, Skokie, IL 60077 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-29 | 5151 Church Street, Suite H, Skokie, IL 60077 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-04-29 | Bengio, Jacob | No data |
| REINSTATEMENT | 1998-04-29 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1997-09-26 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-03-25 |
| ANNUAL REPORT | 2018-04-29 |
| ANNUAL REPORT | 2017-02-23 |
| ANNUAL REPORT | 2016-04-05 |
| ANNUAL REPORT | 2015-02-16 |
| ANNUAL REPORT | 2014-04-20 |
| ANNUAL REPORT | 2013-03-20 |
| ANNUAL REPORT | 2012-04-06 |
| ANNUAL REPORT | 2011-04-18 |
| ANNUAL REPORT | 2010-04-12 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
