| Entity Name: | MOCKINGBIRD QUALITY CARE BEHAVIOR FOCUS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 18 Apr 2016 (9 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 05 Oct 2020 (4 years ago) |
| Document Number: | L16000075910 |
| FEI/EIN Number | 81-2367229 |
| Address: | 5921 RIVA RIDGE DR, WESLEY CHAPEL, FL 33544-6517 |
| Mail Address: | 5921 RIVA RIDGE DR, WESLEY CHAPEL, FL 33544-6517 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356095202 | 2022-02-09 | 2022-02-09 | 5921 RIVA RIDGE DR, WESLEY CHAPEL, FL, 335446517, US | 5921 RIVA RIDGE DR, WESLEY CHAPEL, FL, 335446517, US | |||||||||||||||||||
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| Phone | +1 831-796-1567 |
Authorized person
| Name | DAMION S PETERS |
| Role | WAIVER PROVIDER |
| Phone | 6317961567 |
Taxonomy
| Taxonomy Code | 320900000X - Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 017344800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| THOMAS, DERON | Agent | 31039 Bridgegate, WESLEY CHAPEL, FL 33545 |
| Name | Role | Address |
|---|---|---|
| PETERS, DAMION | Authorized Member | 7070 Bradbury Cir,, WESLEY CHAPEL, FL 33545 |
| THOMAS, DERON | Authorized Member | 31039 Bridgegate Dr, WESLEY CHAPEL, FL 33545 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-08 | 31039 Bridgegate, WESLEY CHAPEL, FL 33545 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-08-04 | 5921 RIVA RIDGE DR, WESLEY CHAPEL, FL 33544-6517 | No data |
| CHANGE OF MAILING ADDRESS | 2023-08-04 | 5921 RIVA RIDGE DR, WESLEY CHAPEL, FL 33544-6517 | No data |
| REINSTATEMENT | 2020-10-05 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-10-05 | THOMAS, DERON | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-02-28 |
| ANNUAL REPORT | 2022-02-22 |
| ANNUAL REPORT | 2021-02-28 |
| REINSTATEMENT | 2020-10-05 |
| ANNUAL REPORT | 2019-01-09 |
| ANNUAL REPORT | 2018-02-16 |
| ANNUAL REPORT | 2017-01-30 |
| Florida Limited Liability | 2016-04-18 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
