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  5. CLAY BEHAVIORAL HEALTH CENTER, INC.

CLAY BEHAVIORAL HEALTH CENTER, INC.

Company Details

Entity Name: CLAY BEHAVIORAL HEALTH CENTER, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 03 Aug 1982 (43 years ago)
Document Number: 764399
FEI/EIN Number 592219317
Address: 3292 COUNTY ROAD 220, MIDDLEBURG, FL, 32068
Mail Address: 41 Knight Boxx Road, Orange Park, FL, 32065, US
ZIP code: 32068
County: Clay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1841934510 2022-04-27 2022-04-27 1726 KINGSLEY AVE STE 2, ORANGE PARK, FL, 320734411, US 1726 KINGSLEY AVE STE 26, ORANGE PARK, FL, 320734401, US

Contacts
Phone +1 904-278-5644

Authorized person
Name HOLLY MCCANN
Role ADMINISTRATIVE ASST./ CREDENTIALING
Phone 9042915561

Taxonomy
Taxonomy Code 251S00000X - Community/Behavioral Health Agency
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CLAY BEHAVIORAL HEALTH CENTER HEALTH AND WELFARE BENEFIT PLAN 2022 592219317 2024-02-29 CLAY BEHAVIORAL HEALTH CENTER, INC. 138
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2022-07-01
Business code 624100
Sponsor’s telephone number 9042915561
Plan sponsor’s mailing address 41 KNIGHT BOXX RD, ORANGE PARK, FL, 320657305
Plan sponsor’s address 41 KNIGHT BOXX RD, ORANGE PARK, FL, 320657305

Number of participants as of the end of the plan year
Active participants 151
Other retired or separated participants entitled to future benefits 9

Signature of
Role Plan administrator
Date 2024-02-29
Name of individual signing IRENE TOTO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-02-29
Name of individual signing IRENE TOTO
Valid signature Filed with authorized/valid electronic signature
CLAY BEHAVIORAL HEALTH CENTER HEALTH AND WELFARE BENEFIT PLAN 2021 592219317 2023-02-16 CLAY BEHAVIORAL HEALTH CENTER, INC. 146
Three-digit plan number (PN) 501
Effective date of plan 2021-07-01
Business code 624100
Sponsor’s telephone number 9042915561
Plan sponsor’s mailing address 1726 KINGSLEY AVE STE 2, ORANGE PARK, FL, 320734411
Plan sponsor’s address 1726 KINGSLEY AVE, ORANGE PARK, FL, 320734463

Number of participants as of the end of the plan year
Active participants 138
Other retired or separated participants entitled to future benefits 10

Signature of
Role Plan administrator
Date 2023-02-16
Name of individual signing IRENE TOTO
Valid signature Filed with authorized/valid electronic signature
CLAY BEHAVIORAL HEALTH CENTER HEALTH AND WELFARE BENEFIT PLAN 2021 592219317 2023-02-24 CLAY BEHAVIORAL HEALTH CENTER, INC. 146
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2021-07-01
Business code 624100
Sponsor’s telephone number 9042915561
Plan sponsor’s mailing address 1726 KINGSLEY AVE STE 2, ORANGE PARK, FL, 320734411
Plan sponsor’s address 1726 KINGSLEY AVE, ORANGE PARK, FL, 320734463

Number of participants as of the end of the plan year
Active participants 138
Other retired or separated participants entitled to future benefits 10

Signature of
Role Plan administrator
Date 2023-02-24
Name of individual signing IRENE TOTO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-02-24
Name of individual signing IRENE TOTO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
TOTO IRENE M Agent 3292 COUNTY ROAD 220, MIDDLEBURG, FL, 32068

Chief Executive Officer

Name Role Address
TOTO IRENE L Chief Executive Officer 8368 CINNAMON CT, JACKSONVILLE, FL, 32244

Othe

Name Role Address
SWATHWOOD TINA Othe 2653 TRAMORE PLACE, ORANGE PARK, FL, 32065

Director

Name Role Address
ELIA MIKE Director 3036 PADDLE CREEK DRIVE, GREEN COVE SPRINGS, FL, 32043
RUTHERFORD KENT Director 205 N. BARTRAM TRAIL, JACKSONVILLE, FL, 322598816

Vice President

Name Role Address
KEENE MARY Vice President 3744 WATERSIDE DRIVE, ORANGE PARK, FL, 32073

BOAR

Name Role Address
ROGERS RACHEL BOAR 862 GLENDALE LANE, ORANGE PARK, FL, 32065

Events

Event Type Filed Date Value Description
NAME CHANGE AMENDMENT 2003-01-17 CLAY BEHAVIORAL HEALTH CENTER, INC. No data
REINSTATEMENT 2001-10-17 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2001-09-21 No data No data
NAME CHANGE AMENDMENT 1994-11-28 CLAY COUNTY BEHAVIORAL HEALTH CENTER, INC. No data
NAME CHANGE AMENDMENT 1991-07-03 CLAY COUNTY COMMUNITY SERVICES, INC. No data
AMENDMENT 1990-11-19 No data No data
REINSTATEMENT 1990-11-19 No data No data
INVOLUNTARILY DISSOLVED 1983-11-10 No data No data
AMENDMENT 1983-02-16 No data No data

Related by officers

ELIA MIKE

WHITE OAK AGRICULTURAL SERVICES LLC

KEENE MARY

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ROGERS RACHEL

REDLANDS GREENWAY DISPENSARY, INC. 3 POINT ALL-STARS LLC TOP NOTCH FLEET SERVICE LLC EAST COAST LANDSCAPE LIGHTING & EXTERIOR AUDIO LLC KENT & ROGERS, INC. NSK - RAR, INC. SAY SOMETHING STUDIOS, INC. JIMMY ROGERS PRODUCTIONS, INC. RAYMOND ROGERS METAL BUILDING INC THE INSTITUTE FOR GROWTH & DEVELOPMENT, INC.

TOTO IRENE M

THE INSTITUTE FOR GROWTH & DEVELOPMENT, INC.

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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