| Entity Name: | VISTA BEHAVIORAL HEALTH, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Apr 2014 (11 years ago) |
| Document Number: | L14000063033 |
| FEI/EIN Number | 46-5422810 |
| Address: | 10607 Cayman Isle Ct, Tampa, FL, 33647, US |
| Mail Address: | 10607 Cayman Isle Ct, Tampa, FL, 33647, US |
| ZIP code: | 33647 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558767376 | 2014-11-05 | 2020-05-19 | 10607 CAYMAN ISLE CT, TAMPA, FL, 336473372, US | 2718 LETAP CT UNIT 101, LAND O LAKES, FL, 346387266, US | |||||||||||||||||||||||||||
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| Phone | +1 813-390-7586 |
| Fax | 8134754794 |
| Phone | +1 813-475-4196 |
Authorized person
| Name | MUHAMMAD ALI |
| Role | PRESIDENT |
| Phone | 8133907586 |
Taxonomy
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| License Number | ME98572 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001476800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ALI MUHAMMAD A | Agent | 10607 Cayman Isle Ct, Tampa, FL, 33647 |
| Name | Role | Address |
|---|---|---|
| ALI MUHAMMAD A | Manager | 10607 Cayman Isle Ct, Tampa, FL, 33647 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-28 | 10607 Cayman Isle Ct, Tampa, FL 33647 | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-28 | 10607 Cayman Isle Ct, Tampa, FL 33647 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-28 | 10607 Cayman Isle Ct, Tampa, FL 33647 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-15 |
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-02-03 |
| AMENDED ANNUAL REPORT | 2022-04-07 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-15 |
| ANNUAL REPORT | 2020-02-05 |
| ANNUAL REPORT | 2019-01-29 |
| ANNUAL REPORT | 2018-01-09 |
| ANNUAL REPORT | 2017-02-08 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
