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  5. VICTORIA NURSING & REHABILITATION CENTER, INC.

VICTORIA NURSING & REHABILITATION CENTER, INC.

Company Details

Entity Name: VICTORIA NURSING & REHABILITATION CENTER, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 15 Jul 1997 (28 years ago)
Document Number: P97000061646
FEI/EIN Number 311558831
Address: 955 NW 3RD ST, MIAMI, FL, 33128
Mail Address: 955 NW 3RD ST, MIAMI, FL, 33128
ZIP code: 33128
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1447249149 2005-10-17 2024-09-04 955 NW 3RD ST, MIAMI, FL, 331281274, US 955 NW 3RD ST, MIAMI, FL, 331281274, US

Contacts
Phone +1 305-548-4020
Fax 3055485018
Fax 3057772000

Authorized person
Name RICHARD STACEY
Role VICE PRESIDENT
Phone 3055484020

Taxonomy
Taxonomy Code 314000000X - Skilled Nursing Facility
License Number SNF130471016
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 022517700
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
VICTORIA NURSING & REHABILITATION CENTER 2015 311558831 2016-10-13 VICTORIA NURSING & REHABILITATION CENTER 155
File View Page
Three-digit plan number (PN) 510
Effective date of plan 2013-05-01
Business code 623000
Sponsor’s telephone number 3055484020
Plan sponsor’s mailing address 955 NW 3RD ST, MIAMI, FL, 331281274
Plan sponsor’s address 955 NW 3RD ST, MIAMI, FL, 331281274

Number of participants as of the end of the plan year
Active participants 152
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2016-10-12
Name of individual signing RALPH STACEY
Valid signature Filed with authorized/valid electronic signature
VICTORIA NURSING & REHABILITATION CENTER 2015 311558831 2016-10-02 VICTORIA NURSING & REHABILITATION CENTER 155
Three-digit plan number (PN) 510
Effective date of plan 2013-05-01
Business code 623000
Sponsor’s telephone number 3055484020
Plan sponsor’s mailing address 955 NW 3RD ST, MIAMI, FL, 331281274
Plan sponsor’s address 955 NW 3RD ST, MIAMI, FL, 331281274

Plan administrator’s name and address
Administrator’s EIN 651056686
Plan administrator’s name PEOPLE FIRST, INC.
Plan administrator’s address 1860 N. PINE ISLAND ROAD #106, PLANTATION, FL, 33322
Administrator’s telephone number 9545876100

Number of participants as of the end of the plan year
Active participants 152
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2016-10-02
Name of individual signing BARBARA FLYNN
Valid signature Filed with authorized/valid electronic signature
VICTORIA NURSING & REHABILITATION CENTER 2014 311558831 2015-08-27 VICTORIA NURSING & REHABILITATION CENTER 161
File View Page
Three-digit plan number (PN) 510
Effective date of plan 2013-05-01
Business code 623000
Sponsor’s telephone number 3055484020
Plan sponsor’s mailing address 955 NW 3 STREET, MIAMI, FL, 33128
Plan sponsor’s address 955 NW 3 STREET, MIAMI, FL, 33128

Number of participants as of the end of the plan year
Active participants 155
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2015-08-27
Name of individual signing RALPH STACEY
Valid signature Filed with authorized/valid electronic signature
VICTORIA NURSING & REHABILITATION CENTER 2012 311558831 2013-09-13 VICTORIA NURSING & REHABILITATION CENTER 104
File View Page
Three-digit plan number (PN) 511
Effective date of plan 2005-06-01
Business code 623000
Sponsor’s telephone number 3055484020
Plan sponsor’s mailing address 955 NW 3 STREET, MIAMI, FL, 33128
Plan sponsor’s address 955 NW 3 STREET, MIAMI, FL, 33128

Number of participants as of the end of the plan year
Active participants 107
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2013-09-13
Name of individual signing RALPH STACEY
Valid signature Filed with authorized/valid electronic signature
VICTORIA NURSING & REHABILITATION CENTER 2012 311558831 2013-09-13 VICTORIA NURSING & REHABILITATION CENTER 122
File View Page
Three-digit plan number (PN) 510
Effective date of plan 2009-05-01
Business code 623000
Sponsor’s telephone number 3055484020
Plan sponsor’s mailing address 955 NW 3 STREET, MIAMI, FL, 33128
Plan sponsor’s address 955 NW 3 STREET, MIAMI, FL, 33128

Number of participants as of the end of the plan year
Active participants 139
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2013-09-13
Name of individual signing RALPH STACEY
Valid signature Filed with authorized/valid electronic signature
VICTORIA NURSING & REHABILITATION CENTER 2011 311558831 2012-09-26 VICTORIA NURSING & REHABILITATION CENTER 125
File View Page
Three-digit plan number (PN) 510
Effective date of plan 2009-05-01
Business code 623000
Plan sponsor’s mailing address 955 NW 3 STREET, MIAMI, FL, 33128
Plan sponsor’s address 955 NW 3 STREET, MIAMI, FL, 33128

Plan administrator’s name and address
Administrator’s EIN 311558831
Plan administrator’s name VICTORIA NURSING & REHABILITATION CENTER
Plan administrator’s address 955 NW 3 STREET, MIAMI, FL, 33128
Administrator’s telephone number 3055484020

Number of participants as of the end of the plan year
Active participants 122
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2012-09-26
Name of individual signing RALPH STACEY
Valid signature Filed with authorized/valid electronic signature
VICTORIA NURSING & REHABILITATION CENTER 2011 311558831 2012-06-27 VICTORIA NURSING & REHABILITATION CENTER 104
File View Page
Three-digit plan number (PN) 511
Effective date of plan 2005-06-01
Business code 623000
Sponsor’s telephone number 3055484020
Plan sponsor’s mailing address 955 NW 3 STREET, MIAMI, FL, 33128
Plan sponsor’s address 955 NW 3 STREET, MIAMI, FL, 33128

Plan administrator’s name and address
Administrator’s EIN 311558831
Plan administrator’s name VICTORIA NURSING & REHABILITATION CENTER
Plan administrator’s address 955 NW 3 STREET, MIAMI, FL, 33128
Administrator’s telephone number 3055484020

Number of participants as of the end of the plan year
Active participants 107
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2012-06-27
Name of individual signing RALPH STACEY
Valid signature Filed with authorized/valid electronic signature
VICTORIA NURSING & REHABILITATION CENTER 2010 311558831 2011-08-12 VICTORIA NURSING & REHABILITATION CENTER 104
File View Page
Three-digit plan number (PN) 510
Effective date of plan 2009-05-01
Business code 623000
Sponsor’s telephone number 3055484020
Plan sponsor’s mailing address 955 NW 3 STREET, MIAMI, FL, 33128
Plan sponsor’s address 955 NW 3 STREET, MIAMI, FL, 33128

Plan administrator’s name and address
Administrator’s EIN 311558831
Plan administrator’s name VICTORIA NURSING & REHABILITATION CENTER
Plan administrator’s address 955 NW 3 STREET, MIAMI, FL, 33128
Administrator’s telephone number 3055484020

Number of participants as of the end of the plan year
Active participants 125
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-08-12
Name of individual signing RALPH STACEY
Valid signature Filed with authorized/valid electronic signature
VICTORIA NURSING & REHABILITATION CENTER 2010 311558831 2011-08-10 VICTORIA NURSING & REHABILITATION CENTER 104
File View Page
Three-digit plan number (PN) 511
Effective date of plan 2005-06-01
Business code 623000
Sponsor’s telephone number 3055484020
Plan sponsor’s mailing address 955 NW 3 STREET, MIAMI, FL, 33128
Plan sponsor’s address 955 NW 3 STREET, MIAMI, FL, 33128

Plan administrator’s name and address
Administrator’s EIN 311558831
Plan administrator’s name VICTORIA NURSING & REHABILITATION CENTER
Plan administrator’s address 955 NW 3 STREET, MIAMI, FL, 33128
Administrator’s telephone number 3055484020

Number of participants as of the end of the plan year
Active participants 101
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-08-10
Name of individual signing RALPH STACEY
Valid signature Filed with authorized/valid electronic signature
VICTORIA NURSING & REHABILITATION CENTER 2009 311558831 2010-05-11 VICTORIA NURSING & REHABILITATION CENTER 132
Three-digit plan number (PN) 510
Effective date of plan 2009-05-01
Business code 623000
Sponsor’s telephone number 3055484020
Plan sponsor’s mailing address 955 NW 3 STREET, MIAMI, FL, 33128
Plan sponsor’s address 955 NW 3 STREET, MIAMI, FL, 33128

Plan administrator’s name and address
Administrator’s EIN 311558831
Plan administrator’s name VICTORIA NURSING & REHABILITATION CENTER
Plan administrator’s address 955 NW 3 STREET, MIAMI, FL, 33128
Administrator’s telephone number 3055484020

Number of participants as of the end of the plan year
Active participants 103
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Employer/plan sponsor
Date 2010-05-11
Name of individual signing RALPH STACEY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
STACEY RICHARD E Agent 899 NW 4TH STREET, MIAMI, FL, 33128

Director

Name Role Address
STACEY RICHARD E Director 899 NW 4TH STREET, MIAMI, FL, 33128

President

Name Role Address
STACEY RICHARD E President 899 NW 4TH STREET, MIAMI, FL, 33128

Events

Event Type Filed Date Value Description
AMENDMENT 2011-08-22 No data No data
NAME CHANGE AMENDMENT 1998-03-25 VICTORIA NURSING & REHABILITATION CENTER, INC. No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J19000628832 LAPSED 2018-030974-CA 01 MIAMI DADE COUNTY, FLORIDA 2019-08-28 2024-09-23 $75,000.00 REGINAL C. DIXON, AS NEXT FRIEND OF ROBERTO MARTINEZ, 1268 N.W. 35 STREET, MIAMI, FL 33142

Related by officers

STACEY RICHARD E

RLS 5401 PARTNERS, LLC SUNSET MANAGEMENT OF CORAL GABLES, LLC VICTORIA MANAGEMENT COMPANY VICTORIA TOWERS, INC. STACEY HEALTH CARE CENTERS, INC. VICTORIA ENTERPRISES, INC. VICTORIA CENTER CONDOMINIUM ASSOCIATION, INC. VICTORIA MANAGEMENT, LLC SOUTH KEY THERAPY SOLUTIONS, LLC

Related by address

No related companies by address

Date of last update: 02 Jan 2025

Sources: Florida Department of State

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