| Entity Name: | PROFESSIONAL PSYCHIATRIC SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Jul 2015 (10 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 11 Dec 2018 (6 years ago) |
| Document Number: | L15000120854 |
| FEI/EIN Number | 475548316 |
| Address: | 5449 S Semoran Blvd, Orlando, FL, 32822, US |
| Mail Address: | 8614 BRACKENWOOD DR, ORLANDO, FL, 32829, US |
| ZIP code: | 32822 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679562797 | 2005-10-20 | 2023-08-24 | 8614 BRACKENWOOD DR, ORLANDO, FL, 328298628, US | 5449 S SEMORAN BLVD STE 20, ORLANDO, FL, 328221778, US | |||||||||||||||||||||||||||
|
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| Phone | +1 407-734-1273 |
Authorized person
| Name | ELBA FLORES |
| Role | PRACTICE MANAGER |
| Phone | 4077341273 |
Taxonomy
| Taxonomy Code | 171M00000X - Case Manager/Care Coordinator |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | 6722 |
| State | PR |
| Is Primary | Yes |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| FLORES ELBA | Agent | 8614 BRACKENWOOD DR, ORLANDO, FL, 32829 |
| Name | Role | Address |
|---|---|---|
| FLORES ELBA | Auth | 8614 BRACKENWOOD DR, ORLANDO, FL, 32829 |
| Name | Role | Address |
|---|---|---|
| FUENTES FLORES ANEL | Secretary | 8614 BRACKENWOOD DR, ORLANDO, FL, 32829 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000035169 | PPS ACADEMY | ACTIVE | 2024-03-08 | 2029-12-31 | No data | 8614 BRACKENWOOD DR, ORLANDO, FL, 32829 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-02-25 | 5449 S Semoran Blvd, Suite 20, Orlando, FL 32822 | No data |
| LC AMENDMENT | 2018-12-11 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-12-11 | FLORES, ELBA | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-12 |
| ANNUAL REPORT | 2023-04-03 |
| ANNUAL REPORT | 2022-04-08 |
| ANNUAL REPORT | 2021-02-25 |
| ANNUAL REPORT | 2020-01-12 |
| ANNUAL REPORT | 2019-01-06 |
| LC Amendment | 2018-12-11 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-01-13 |
| ANNUAL REPORT | 2016-04-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
