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  5. PALM BEACH BEHAVIORAL HEALTH AND WELLNESS, LLC

PALM BEACH BEHAVIORAL HEALTH AND WELLNESS, LLC

Company Details

Entity Name: PALM BEACH BEHAVIORAL HEALTH AND WELLNESS, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Company
Status: Active
Date Filed: 04 Nov 2011 (13 years ago)
Document Number: L11000125929
FEI/EIN Number 45-3740111
Address: 5220 Hood Rd, Suite 101, Palm Beach Gardens, FL 33418
Mail Address: 5220 Hood Rd, Suite 101, Palm Beach Gardens, FL 33418
ZIP code: 33418
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1982971800 2011-11-21 2011-11-21 221 GREENWICH CIR, SUITE 111, JUPITER, FL, 334582890, US 221 GREENWICH CIR, SUITE 111, JUPITER, FL, 334582890, US

Contacts
Phone +1 312-758-0424

Authorized person
Name BRANDI RIALS
Role OWNER
Phone 3127580424

Taxonomy
Taxonomy Code 103TC0700X - Clinical Psychologist
License Number PY8421
State FL
Is Primary Yes

Other Provider Identifiers
Issuer NPI
Number 1235419854
Issuer NPI
Number 1700116829

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 401(K) PLAN 2023 453740111 2024-02-14 PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621498
Sponsor’s telephone number 5614292397
Plan sponsor’s address 345 JUPITER LAKE BOULEVARD, SUITE 302A, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2024-02-14
Name of individual signing KELLY EVERSON
Valid signature Filed with authorized/valid electronic signature
PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 401(K) PLAN 2022 453740111 2023-01-25 PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621498
Sponsor’s telephone number 5614292397
Plan sponsor’s address 345 JUPITER LAKE BOULEVARD, SUITE 302A, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2023-01-25
Name of individual signing KELLY EVERSON
Valid signature Filed with authorized/valid electronic signature
PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 401(K) PLAN 2021 453740111 2022-02-01 PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621498
Sponsor’s telephone number 5614292397
Plan sponsor’s address 345 JUPITER LAKE BOULEVARD, SUITE 302A, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2022-02-01
Name of individual signing KELLY EVERSON
Valid signature Filed with authorized/valid electronic signature
PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 401(K) PLAN 2020 453740111 2021-02-02 PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621498
Sponsor’s telephone number 5614292397
Plan sponsor’s address 345 JUPITER LAKE BOULEVARD, SUITE 302A, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2021-02-02
Name of individual signing KELLY EVERSON
Valid signature Filed with authorized/valid electronic signature
PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 401(K) PLAN 2019 453740111 2020-02-19 PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621498
Sponsor’s telephone number 5614292397
Plan sponsor’s address 345 JUPITER LAKE BOULEVARD, SUITE 302A, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2020-02-19
Name of individual signing KELLY EVERSON
Valid signature Filed with authorized/valid electronic signature
PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 401(K) PLAN 2018 453740111 2019-01-22 PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621498
Sponsor’s telephone number 5614292397
Plan sponsor’s address 345 JUPITER LAKE BOULEVARD, SUITE 302A, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2019-01-22
Name of individual signing KELLY EVERSON
Valid signature Filed with authorized/valid electronic signature
PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 401(K) PLAN 2017 453740111 2018-01-24 PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621498
Sponsor’s telephone number 5614292397
Plan sponsor’s address 345 JUPITER LAKE BOULEVARD, SUITE 302A, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2018-01-24
Name of individual signing KELLY EVERSON
Valid signature Filed with authorized/valid electronic signature
PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 401(K) PLAN 2016 453740111 2017-03-02 PALM BEACH BEHAVIORAL HEALTH AND WELLNESS LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621498
Sponsor’s telephone number 5614292397
Plan sponsor’s address 345 JUPITER LAKE BOULEVARD, SUITE 302A, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2017-03-02
Name of individual signing KELLY EVERSON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
RIALS, BRANDI M Agent 5220 Hood Rd, Suite 101, Palm Beach Gardens, FL 33418

Managing Member

Name Role Address
RIALS, BRANDI M Managing Member 5220 Hood Rd, Suite 101 Palm Beach Gardens, FL 33418
EVERSON, KELLY Managing Member 5220 Hood Rd, Suite 101 Palm Beach Gardens, FL 33418

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-04-24 5220 Hood Rd, Suite 101, Palm Beach Gardens, FL 33418 No data
CHANGE OF MAILING ADDRESS 2024-04-24 5220 Hood Rd, Suite 101, Palm Beach Gardens, FL 33418 No data
REGISTERED AGENT ADDRESS CHANGED 2024-04-24 5220 Hood Rd, Suite 101, Palm Beach Gardens, FL 33418 No data

Documents

Name Date
ANNUAL REPORT 2024-04-24
ANNUAL REPORT 2023-04-02
ANNUAL REPORT 2022-03-30
ANNUAL REPORT 2021-04-19
ANNUAL REPORT 2020-05-31
ANNUAL REPORT 2019-02-06
ANNUAL REPORT 2018-03-01
ANNUAL REPORT 2017-01-07
ANNUAL REPORT 2016-03-11
ANNUAL REPORT 2015-01-08

Related by officers

RIALS, BRANDI M

INTEGRATED HEALTH & EDUCATION, LLC

EVERSON, KELLY

PALM BEACH BEHAVIORAL HEALTH FOUNDATION INC.

Related by address

No related companies by address

Date of last update: 22 Feb 2025

Sources: Florida Department of State

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