| Entity Name: | BRANDON PSYCHIATRIC GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 May 2014 (11 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 13 Dec 2022 (2 years ago) |
| Document Number: | L14000074643 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 106 W WINDHORST RD., BRANDON, FL, 33510, US |
| Mail Address: | P.O. Box 1584, Cumming, GA, 30028, US |
| ZIP code: | 33510 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952710147 | 2014-08-13 | 2019-02-06 | PO BOX 1584, CUMMING, GA, 300281584, US | 106 W WINDHORST RD, BRANDON, FL, 335102455, US | |||||||||||||||||||||||||
|
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| Phone | +1 678-923-6025 |
| Fax | 8134136660 |
Authorized person
| Name | DR. HANY BOTROS MIKHAIL |
| Role | PRESIDENT |
| Phone | 6789236025 |
Taxonomy
| Taxonomy Code | 2084B0040X - Behavioral Neurology & Neuropsychiatry Physician |
| License Number | 95351 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 275940302 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Mikhail Ihab | Agent | 106 W WINDHORST RD., BRANDON, FL, 33510 |
| Name | Role | Address |
|---|---|---|
| MIKHAIL Hany | Manager | 106 W Windhorst Rd., Brandon, FL, 33510 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2022-12-13 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-12-13 | Mikhail, Ihab | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-12-13 | 106 W WINDHORST RD., BRANDON, FL 33510 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-16 | 106 W WINDHORST RD., BRANDON, FL 33510 | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-16 | 106 W WINDHORST RD., BRANDON, FL 33510 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-26 |
| ANNUAL REPORT | 2023-03-08 |
| REINSTATEMENT | 2022-12-13 |
| Reg. Agent Resignation | 2021-10-29 |
| ANNUAL REPORT | 2021-04-16 |
| ANNUAL REPORT | 2020-01-28 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-03-30 |
| ANNUAL REPORT | 2017-03-14 |
| ANNUAL REPORT | 2016-03-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
