| Entity Name: | LAKE MARY PSYCHIATRIC SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
LAKE MARY PSYCHIATRIC SERVICES, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 20 Jan 2005 (20 years ago) |
| Date of dissolution: | 26 Sep 2008 (17 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2008 (17 years ago) |
| Document Number: | L05000006010 |
| FEI/EIN Number |
NOT APPLICABLE
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 101 TIMBERLACHEN CIRCLE, SUITE 201, LAKE MARY, FL, 32746, US |
| Mail Address: | 1332 CHESSINGTON CIRCLE, HEATHROW, FL, 32746, US |
| ZIP code: | 32746 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285679902 | 2006-06-17 | 2020-08-22 | 101 TIMBERLACHEN CIR, SUITE 201, LAKE MARY, FL, 327466124, US | 101 TIMBERLACHEN CIR, SUITE 201, LAKE MARY, FL, 327466124, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-330-5818 |
| Fax | 4073305820 |
Authorized person
| Name | MANUEL R. MOTA-CASTILLO |
| Role | PSYCHIATRIC/MEDICAL DIRECTOR |
| Phone | 4073305818 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME-82747 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 7771009 |
| State | FL |
| Issuer | MENTAL HEALTH NETWORK |
| Number | 111973343307 |
| State | FL |
| Issuer | HARMONY BEHAVIORAL HEALTH |
| Number | 272693 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 52339 |
| State | FL |
| Issuer | VALUE OPTIONS |
| Number | 543580 |
| State | FL |
| Issuer | AMERIGROUP |
| Number | 110962 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MOTA-CASTILLO MANUEL R | Manager | 1332 CHESSINGTON CIRCLE, HEATHROW, FL, 32746 |
| SALJA-MOTA ROSA M | Manager | 1332 CHESSINGTON CIRCLE, HEATHROW, FL, 32746 |
| MEDAL JEANETTE | Manager | 101 TIMBERLACHEN CIRCLE, LAKE MARY, FL, 32746 |
| MOTA-CASTILLO MANUEL R | Agent | 1332 CHESSINGTON CIRCLE, HEATHROW, FL, 32746 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2007-01-04 |
| ANNUAL REPORT | 2006-01-03 |
| Florida Limited Liability | 2005-01-20 |
Date of last update: 01 May 2025
Sources: Florida Department of State
