| Entity Name: | PSI BEHAVIORAL HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
PSI 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: | 19 Jul 2013 (12 years ago) |
| Document Number: | L13000102409 |
| FEI/EIN Number |
46-3202761
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 3450 DUNN AVE., SUITE 201, JACKSONVILLE, FL, 32218, US |
| Mail Address: | 3450 DUNN AVE., SUITE 201, JACKSONVILLE, FL, 32218, US |
| ZIP code: | 32218 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063847465 | 2013-09-05 | 2013-09-05 | 3890 DUNN AVE, SUITE 1104, JACKSONVILLE, FL, 322186428, US | 3890 DUNN AVE, SUITE 1104, JACKSONVILLE, FL, 322186428, US | |||||||||||||||||||
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| Phone | +1 904-723-6049 |
Authorized person
| Name | MR. RICKY WALLACE |
| Role | CEO |
| Phone | 9047236049 |
Taxonomy
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PENDING |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WALLACE RICKY B | Managing Member | 3450 DUNN AVE. SUITE 201, JACKSONVILLE, FL, 32218 |
| Wallace Janice | Auth | 3450 DUNN AVE., JACKSONVILLE, FL, 32218 |
| REGISTERED AGENTS INC | Agent | - |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-02-17 | Registered Agents Inc. | - |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-17 | 7901 4th St N, Suite 300, St. Petersburg, FL 33702 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-30 | 3450 DUNN AVE., SUITE 201, JACKSONVILLE, FL 32218 | - |
| CHANGE OF MAILING ADDRESS | 2019-04-30 | 3450 DUNN AVE., SUITE 201, JACKSONVILLE, FL 32218 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-17 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-09-23 |
| ANNUAL REPORT | 2020-07-04 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-30 |
| ANNUAL REPORT | 2016-04-21 |
| ANNUAL REPORT | 2015-04-22 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 2868707301 | 2020-04-29 | 0491 | PPP | 3450 Dunn Ave Ste 201, JACKSONVILLE, FL, 32218 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 03 Mar 2025
Sources: Florida Department of State
