| Entity Name: | CRAFT BEHAVIORAL HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
CRAFT BEHAVIORAL HEALTH, 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: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 26 Oct 2009 (15 years ago) |
| Last Event: | LC AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 05 Jul 2011 (14 years ago) |
| Document Number: | L09000103276 |
| FEI/EIN Number |
271196824
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 10175 FORTUNE PARKWAY SUITE #1106, JACKSONVILLE, FL, 32256, US |
| Mail Address: | 10175 FORTUNE PARKWAY SUITE #1106, JACKSONVILLE, FL, 32256, US |
| ZIP code: | 32256 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639491632 | 2010-02-18 | 2011-07-21 | 10175 FORTUNE PKWY, SUITE #1106, JACKSONVILLE, FL, 322566746, US | 10175 FORTUNE PKWY, SUITE #1106, JACKSONVILLE, FL, 322566746, US | |||||||||||||||||||||
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| Phone | +1 904-379-5928 |
| Fax | 9043795967 |
Authorized person
| Name | DR. MOHAMMAD FAROOQUE |
| Role | PRESIDENT |
| Phone | 9043795928 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BC/BS OF FL |
| Number | 1455P |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CRAFT BEHAVIORAL HEALTH LLC 401(K) PLAN | 2023 | 271196824 | 2024-06-01 | CRAFT BEHAVIORAL HEALTH LLC | 16 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-06-01 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621112 |
| Sponsor’s telephone number | 9044958269 |
| Plan sponsor’s address | 10175 FORTUNE PARKWAY, UNIT 1106, JACKSONVILLE, FL, 32256 |
Plan administrator’s name and address
| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2023-05-28 |
| Name of individual signing | CHRISTINE RIMER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| FAROOQUE MOHAMMAD | Managing Member | 10175 FORTUNE PARWAY #1106, JACKSONVILLE, FL, 32256 |
| CRAFT BEHAVIORAL HEALTH, LLC | Agent | - |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000121641 | CRAFT CLINIC | ACTIVE | 2024-09-30 | 2029-12-31 | - | 10175 FORTUNE PARKWAY, SUITE 1106, JACKSONVILLE, FL, 32256 |
| G22000117377 | CRAFT LASER CLINIC | ACTIVE | 2022-09-17 | 2027-12-31 | - | 10175 FORTUNE PARKWAY, UNIT 1106, JACKSONVILLE, FL, 32256 |
| G22000101405 | NEUROPSYCHIATRIC ASSOCIATES | ACTIVE | 2022-08-27 | 2027-12-31 | - | 10175 FORTUNE PARKWAY, UNIT 1106, JACKSONVILLE, FL, 32256 |
| G21000087078 | CRAFT MEDICAL MARIJUANA CLINIC | ACTIVE | 2021-06-30 | 2026-12-31 | - | 10175 FORTUNE PARKWAY, UNIT 1106, JACKSONVILLE, FL, 32256 |
| G18000011326 | CRAFT CLINIC | EXPIRED | 2018-01-21 | 2023-12-31 | - | 10175 FORTUNE PARKWAY, SUITE 1106, JACKSONVILLE, FL, 32256 |
| G11000077795 | NEUROPSYCHIATRIC ASSOCIATES, LLC | EXPIRED | 2011-08-16 | 2016-12-31 | - | 10175 FORTUNE PKWY., #1106, JACKSONVILLE, FL, 32256 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-02-28 | Craft Behavioral Health LLC | - |
| LC AMENDMENT AND NAME CHANGE | 2011-07-05 | CRAFT BEHAVIORAL HEALTH, LLC | - |
| LC AMENDMENT AND NAME CHANGE | 2011-06-03 | NEUROPSYCHIATRIC BEHAVIORAL HEALTH, LLC | - |
| CHANGE OF PRINCIPAL ADDRESS | 2010-06-07 | 10175 FORTUNE PARKWAY SUITE #1106, JACKSONVILLE, FL 32256 | - |
| CHANGE OF MAILING ADDRESS | 2010-06-07 | 10175 FORTUNE PARKWAY SUITE #1106, JACKSONVILLE, FL 32256 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2010-06-07 | 10175 FORTUNE PARKWAY SUITE #1106, JACKSONVILLE, FL 32256 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-23 |
| ANNUAL REPORT | 2024-01-22 |
| ANNUAL REPORT | 2023-01-15 |
| ANNUAL REPORT | 2022-02-13 |
| ANNUAL REPORT | 2021-02-28 |
| ANNUAL REPORT | 2020-02-07 |
| ANNUAL REPORT | 2019-04-06 |
| ANNUAL REPORT | 2018-01-21 |
| ANNUAL REPORT | 2017-01-05 |
| ANNUAL REPORT | 2016-01-23 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 7364608900 | 2021-05-07 | 0491 | PPS | 10175 Fortune Pkwy Unit 1106, Jacksonville, FL, 32256-6757 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 7612247402 | 2020-05-16 | 0491 | PPP | 10175 FORTUNE PKWY UNIT 1106, JACKSONVILLE, FL, 32256-6757 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Apr 2025
Sources: Florida Department of State
