| Entity Name: | SPIRES BEHAVIORAL HEALTH CARE CENTER, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 27 May 2008 (17 years ago) |
| Document Number: | L08000052248 |
| FEI/EIN Number | 26-2721498 |
| Address: | 2880 Green Street, MARIANNA, FL 32447 |
| Mail Address: | PO BOX 5728, MARIANNA, FL 32447-5728 |
| ZIP code: | 32447 |
| County: | Jackson |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821406000 | 2014-07-31 | 2014-07-31 | PO BOX 5728, 4428 LAFAYETTE STREET, MARIANNA, FL, 324475728, US | 4428 LAFAYETTE STREET, MARIANNA, FL, 324475728, US | |||||||||||||||||||||||||||||||
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| Phone | +1 850-482-4177 |
| Fax | 8504824178 |
Authorized person
| Name | DR. WILLIE EARL SPIRES |
| Role | EXECUTIVE DIRECTOR |
| Phone | 8504824177 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH0026 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MAGELLAN BEHAVIORAL HEALTH |
| Number | 600562012 |
| State | FL |
| Issuer | MEDICAID |
| Number | 000258100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SPIRES, MARTHA R | Agent | 4818 EBONY COURT, MARIANNA, FL 32446 |
| Name | Role | Address |
|---|---|---|
| SPIRES, WILLIE E, Phd | Managing Member | 2880 Green Street, Post Office Box 5728 MARIANNA, FL 32447 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2015-05-01 | 2880 Green Street, MARIANNA, FL 32447 | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-30 | 2880 Green Street, MARIANNA, FL 32447 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-04-07 |
| ANNUAL REPORT | 2020-07-02 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-21 |
| ANNUAL REPORT | 2016-04-30 |
| ANNUAL REPORT | 2015-05-01 |
Date of last update: 26 Jan 2025
Sources: Florida Department of State
