| Entity Name: | BAPTIST BEHAVIORAL HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 Oct 2013 (11 years ago) |
| Last Event: | LC AMENDED AND RESTATED ARTICLES |
| Event Date Filed: | 01 Jul 2019 (6 years ago) |
| Document Number: | L13000145385 |
| FEI/EIN Number | 46-4629700 |
| Address: | 841 PRUDENTIAL DRIVE, SUITE 1601, JACKSONVILLE, FL, 32207, US |
| Mail Address: | 841 PRUDENTIAL DRIVE, SUITE 1601, JACKSONVILLE, FL, 32207, US |
| ZIP code: | 32207 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164155974 | 2022-07-08 | 2022-07-08 | PO BOX 748519, ATLANTA, GA, 303748519, US | 1650 PRUDENTIAL DR STE 210, JACKSONVILLE, FL, 322078149, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 904-376-3800 |
| Fax | 9043763998 |
Authorized person
| Name | ELIZABETH TISH DE MEDICI |
| Role | CREDENTIALING MGR |
| Phone | 9043763800 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 103T00000X - Psychologist |
| Is Primary | Yes |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Baity G. S | Agent | 841 PRUDENTIAL DRIVE, JACKSONVILLE, FL, 32207 |
| Name | Role |
|---|---|
| SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INC. | Auth |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000041683 | BAPTIST MEDICAL GROUP | ACTIVE | 2024-03-25 | 2029-12-31 | No data | 841 PRUDENTIAL DRIVE, STE 1601, JACKSONVILLE, FL, 32207 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDED AND RESTATED ARTICLES | 2019-07-01 | No data | No data |
| REINSTATEMENT | 2018-10-18 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-10-18 | Baity, G. Scott | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REINSTATEMENT | 2016-10-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-04-03 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-05-07 |
| ANNUAL REPORT | 2020-07-20 |
| LC Amended and Restated Art | 2019-07-01 |
| ANNUAL REPORT | 2019-04-30 |
| REINSTATEMENT | 2018-10-18 |
| ANNUAL REPORT | 2017-06-30 |
| REINSTATEMENT | 2016-10-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
