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  5. BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC

BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC

Company Details

Entity Name: BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 12 Jul 2012 (13 years ago)
Document Number: L12000091102
FEI/EIN Number 46-0549337
Address: 6816 Southpoint Parkway, Jacksonville, FL, 32216, US
Mail Address: 6816 Southpoint Parkway, Jacksonville, FL, 32216, US
ZIP code: 32216
County: Duval
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1770838872 2012-07-16 2018-06-16 6816 SOUTHPOINT PKWY STE 202, JACKSONVILLE, FL, 322161701, US 6816 SOUTHPOINT PKWY STE 202, JACKSONVILLE, FL, 322161701, US

Contacts
Phone +1 904-419-7792
Fax 9049007732

Authorized person
Name DR. ADRIENNE LEIGH DESANTIS KING
Role MANAGING MEMBER/OWNER/PSYCHOLOGIST
Phone 9044197792

Taxonomy
Taxonomy Code 103K00000X - Behavior Analyst
Is Primary No
Taxonomy Code 103T00000X - Psychologist
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC 401(K) PLAN 2023 460549337 2024-08-22 BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621399
Sponsor’s telephone number 9044187792
Plan sponsor’s address 6816 SOUTHPOINT PARKWAY, SUITE 202, JACKSONVILLE, FL, 32216

Signature of
Role Plan administrator
Date 2024-08-22
Name of individual signing PARAS NABIZADEH, PSY.D., BCBA-D
Valid signature Filed with authorized/valid electronic signature
BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC 401(K) PLAN 2022 460549337 2023-04-24 BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621399
Sponsor’s telephone number 9044187792
Plan sponsor’s address 6816 SOUTHPOINT PARKWAY, SUITE 202, JACKSONVILLE, FL, 32216

Signature of
Role Plan administrator
Date 2023-04-24
Name of individual signing PARAS NABIZADEH, PSY.D., BCBA-D
Valid signature Filed with authorized/valid electronic signature
BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC 401(K) PLAN 2021 460549337 2022-10-11 BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621399
Sponsor’s telephone number 9044187792
Plan sponsor’s address 6816 SOUTHPOINT PARKWAY, SUITE 202, JACKSONVILLE, FL, 32216

Signature of
Role Plan administrator
Date 2022-10-11
Name of individual signing PARAS NABIZADEH, PSY.D., BCBA-D
Valid signature Filed with authorized/valid electronic signature
BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC 401(K) PLAN 2020 460549337 2021-06-11 BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621399
Sponsor’s telephone number 9044187792
Plan sponsor’s address 6816 SOUTHPOINT PARKWAY, SUITE 202, JACKSONVILLE, FL, 32216

Signature of
Role Plan administrator
Date 2021-06-11
Name of individual signing PARAS NABIZADEH, PSY.D., BCBA-D
Valid signature Filed with authorized/valid electronic signature
BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC 401(K) PLAN 2019 460549337 2020-09-02 BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621399
Sponsor’s telephone number 9044187792
Plan sponsor’s address 6816 SOUTHPOINT PARKWAY, SUITE 202, JACKSONVILLE, FL, 32216

Signature of
Role Plan administrator
Date 2020-09-02
Name of individual signing PARAS NABIZADEH, PSY.D., BCBA-D
Valid signature Filed with authorized/valid electronic signature
BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC 401(K) PLAN 2018 460549337 2019-07-16 BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621399
Sponsor’s telephone number 9044187792
Plan sponsor’s address 6816 SOUTHPOINT PARKWAY, SUITE 202, JACKSONVILLE, FL, 32216

Signature of
Role Plan administrator
Date 2019-07-16
Name of individual signing PARAS NABIZADEH, PSY.D., BCBA-D
Valid signature Filed with authorized/valid electronic signature
BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC 401(K) PLAN 2017 460549337 2018-10-09 BEACON PEDIATRIC BEHAVIORAL HEALTH, LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621399
Sponsor’s telephone number 9044187792
Plan sponsor’s address 6816 SOUTHPOINT PARKWAY, SUITE 202, JACKSONVILLE, FL, 32216

Signature of
Role Plan administrator
Date 2018-10-09
Name of individual signing PARAS NABIZADEH, PSY.D., BCBA-D
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DeSantis King Adrienne Agent 6816 Southpoint Parkway, JACKSONVILLE, FL, 32216

Managing Member

Name Role Address
DESANTIS KING ADRIENNE Managing Member 2754 CHAPMAN OAK DR., JACKSONVILLE, FL, 32257
NABIZADEH PARAS Managing Member 14091 CAHABA RD, JACKSONVILLE, FL, 32224

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2019-04-03 DeSantis King, Adrienne No data
REGISTERED AGENT ADDRESS CHANGED 2019-04-03 6816 Southpoint Parkway, Suite 202, JACKSONVILLE, FL 32216 No data
CHANGE OF PRINCIPAL ADDRESS 2016-03-27 6816 Southpoint Parkway, Suite 202, Jacksonville, FL 32216 No data
CHANGE OF MAILING ADDRESS 2016-03-27 6816 Southpoint Parkway, Suite 202, Jacksonville, FL 32216 No data

Documents

Name Date
ANNUAL REPORT 2024-05-15
ANNUAL REPORT 2023-01-19
ANNUAL REPORT 2022-01-25
ANNUAL REPORT 2021-04-24
ANNUAL REPORT 2020-07-18
ANNUAL REPORT 2019-04-03
ANNUAL REPORT 2018-04-28
ANNUAL REPORT 2017-04-29
ANNUAL REPORT 2016-03-27
ANNUAL REPORT 2015-04-08

Related by officers

No related officers

Related by address

6816 Southpoint Parkway, Jacksonville, FL, 32216, US

E-ZASSI, LLC FLORIDA SOCIETY OF PATHOLOGISTS, INC.

6816 Southpoint Parkway, Jacksonville, FL, 32216, US

E-ZASSI, LLC FLORIDA SOCIETY OF PATHOLOGISTS, INC.

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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