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  5. NORTHSIDE BEHAVIORAL HEALTH CENTER, INC.

NORTHSIDE BEHAVIORAL HEALTH CENTER, INC.

Company Details

Entity Name: NORTHSIDE BEHAVIORAL HEALTH CENTER, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 11 Dec 1975 (49 years ago)
Document Number: 734578
FEI/EIN Number 591641327
Address: 12512 BRUCE B. DOWNS BLVD., TAMPA, FL, 33612, US
Mail Address: 12512 BRUCE B. DOWNS BLVD., TAMPA, FL, 33612, US
ZIP code: 33612
County: Hillsborough
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1750644811 2012-06-22 2023-08-01 2995 DREW ST FL 2, CLEARWATER, FL, 337593012, US 12512 BRUCE B DOWNS BLVD, TAMPA, FL, 336129209, US

Contacts
Phone +1 727-315-6974
Fax 8136352613
Phone +1 813-977-8700
Fax 8139712029

Authorized person
Name LYNDA GORKEN
Role VICE PRESIDENT
Phone 7272819202

Taxonomy
Taxonomy Code 251B00000X - Case Management Agency
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 117580100
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NORTHSIDE BEHAVIORAL HEALTH CENTER, INC. 2016 591641327 2018-01-12 NORTHSIDE BEHAVIORAL HEALTH CENTER, INC. 129
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1994-07-01
Business code 621420
Sponsor’s telephone number 8139778700
Plan sponsor’s mailing address 12512 BRUCE B. DOWNS BLVD., TAMPA, FL, 33612
Plan sponsor’s address 12512 BRUCE B. DOWNS BLVD., TAMPA, FL, 33612

Number of participants as of the end of the plan year
Active participants 95
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2018-01-12
Name of individual signing KRISTY SMITHWICK
Valid signature Filed with authorized/valid electronic signature
NORTHSIDE BEHAVIORAL HEALTH CENTER, INC. 2015 591641327 2017-04-17 NORTHSIDE BEHAVIORAL HEALTH CENTER, INC. 127
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1994-07-01
Business code 621420
Sponsor’s telephone number 8139778700
Plan sponsor’s mailing address 12512 BRUCE B DOWNS BLVD, TAMPA, FL, 336129209
Plan sponsor’s address 12512 BRUCE B DOWNS BLVD, TAMPA, FL, 336129209

Number of participants as of the end of the plan year
Active participants 118
Retired or separated participants receiving benefits 2
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2017-04-17
Name of individual signing ELAINE CHURTON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-04-17
Name of individual signing ELAINE CHURTON
Valid signature Filed with authorized/valid electronic signature
NORTHSIDE BEHAVIORAL HEALTH CENTER, INC. 2014 591641327 2016-03-03 NORTHSIDE BEHAVIORAL HEALTH CENTER, INC. 141
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1994-07-01
Business code 621420
Sponsor’s telephone number 8139778700
Plan sponsor’s mailing address 12512 BRUCE B. DOWNS BLVD., TAMPA, FL, 33612
Plan sponsor’s address 12512 BRUCE B. DOWNS BLVD., TAMPA, FL, 33612

Number of participants as of the end of the plan year
Active participants 129
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2016-03-03
Name of individual signing GLEN BLONQUIST
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-03-03
Name of individual signing GLEN BLONQUIST
Valid signature Filed with authorized/valid electronic signature
NORTHSIDE BEHAVIORAL HEALTH CENTER, INC. 2013 591641327 2015-03-04 NORTHSIDE BEHAVIORAL HEALTH CENTER, INC. 169
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1994-07-01
Business code 621420
Sponsor’s telephone number 8139778700
Plan sponsor’s mailing address 12512 BRUCE B. DOWNS BLVD., TAMPA, FL, 33612
Plan sponsor’s address 12512 BRUCE B. DOWNS BLVD., TAMPA, FL, 33612

Number of participants as of the end of the plan year
Active participants 139
Retired or separated participants receiving benefits 3
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2015-03-04
Name of individual signing GLEN BLONQUIST
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-03-04
Name of individual signing GLEN BLONQUIST
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
BAYCARE HEALTH SYSTEM, INC. Agent

Vice President

Name Role Address
Ryder Gail Vice President 2985 Drew Street, Clearwater, FL, 33759

Treasurer

Name Role Address
Beamon Ron Treasurer 2985 Drew Street, Clearwater, FL, 33759

Chairman

Name Role Address
Galdieri Lou Chairman 2985 Drew Street, Clearwater, FL, 33759

Events

Event Type Filed Date Value Description
AMENDED AND RESTATEDARTICLES 2021-02-01 No data No data
NAME CHANGE AMENDMENT 2014-08-22 NORTHSIDE BEHAVIORAL HEALTH CENTER, INC. No data
NAME CHANGE AMENDMENT 1995-02-06 NORTHSIDE MENTAL HEALTH CENTER, INC. No data
NAME CHANGE AMENDMENT 1993-07-07 NORTHSIDE MENTAL HEALTH HOSPITAL, INCORPORATED No data
NAME CHANGE AMENDMENT 1986-04-25 NORTHSIDE CENTERS, INCORPORATED No data
AMENDMENT 1986-04-23 No data No data

Related by officers

Ryder Gail

NORTHSIDE PROPERTIES, INC.

Beamon Ron

BAY LINEN, INC. BEHAVIORAL HEALTH MANAGEMENT SERVICES, INC. BAYCARE BEHAVIORAL HEALTH, INC. NORTHSIDE PROPERTIES, INC. HBHCI HOME CORPORATION

Galdieri Lou

WINTER HAVEN HOSPITAL, INC. BEHAVIORAL HEALTH MANAGEMENT SERVICES, INC. BAYCARE BEHAVIORAL HEALTH, INC. NORTHSIDE PROPERTIES, INC. ST. ANTHONY'S HOSPITAL, INC. ST. ANTHONY'S PROFESSIONAL BUILDINGS AND SERVICES, INC. MORTON PLANT MEASE HEALTH CARE, INC. TRUSTEES OF MEASE HOSPITAL, INC. MORTON PLANT HOSPITAL ASSOCIATION, INC. BAYCARE HEALTH SYSTEM, INC.

Related by address

No related companies by address

Date of last update: 03 Jan 2025

Sources: Florida Department of State

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