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340 DeSoto Avenue Ext Operations, LLC

Branch

Company Details

Name: 340 DeSoto Avenue Ext Operations, LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 03 Jan 2022 (3 years ago)
Branch of: 340 DeSoto Avenue Ext Operations, LLC, FLORIDA (Company Number L22000000211)
Business ID: 1317611
ZIP code: 38614
County: Coahoma
State of Incorporation: FLORIDA
Principal Office Address: 340 DeSoto Ave. Ext.Clarksdale, MS 38614
Fictitious names: Greenbough Health and Rehabilitation Center

Agent

Name Role Address
CORPORATION SERVICE COMPANY Agent 109 Executive Drive, Suite 3, Madison, MS 39110

Member

Name Role Address
FGLFC Holdco, LLC Member 1040 Crown Pointe Pkwy., Ste. 600, Atlanta, GA 30338

National Provider Identifier

NPI Number:
1932856531
Certification Date:
2024-09-13

Authorized Person:

Name:
TIM LEHNER
Role:
MANAGHER
Phone:

Taxonomy:

Selected Taxonomy:
314000000X - Skilled Nursing Facility
Is Primary:
Yes

Contacts:

Fax:
6626275654

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2025-04-09 Annual Report For 340 DeSoto Avenue Ext Operations, LLC
Annual Report LLC Filed 2024-04-15 Annual Report For 340 DeSoto Avenue Ext Operations, LLC
Annual Report LLC Filed 2023-04-13 Annual Report For 340 DeSoto Avenue Ext Operations, LLC
Registered Agent Change of Address Filed 2022-03-31 Agent Address Change For CORPORATION SERVICE COMPANY
Fictitious Name Registration Filed 2022-02-28 Fictitious Name Registration For 340 DeSoto Avenue Ext Operations, LLC
Formation Form Filed 2022-01-03 Formation For 340 DeSoto Avenue Ext Operations, LLC

OSHA's Inspections within Industry

Inspection Summary

Date:
2021-08-19
Type:
Referral
Address:
340 DESOTO AVE. EXT., CLARKSDALE, MS, 38614
Safety Health:
Health
Scope:
Complete

Date of last update: 28 May 2025

Sources: Company Profile on Mississippi Secretary of State Website