| Entity Name: | QUALICARE PSYCHIATRY L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Jul 2016 (9 years ago) |
| Document Number: | L16000138571 |
| FEI/EIN Number | 813365138 |
| Address: | 42735 US HWY 27,, South State bank Building, DAVENPORT, FL, 33837, US |
| Mail Address: | 42735 US HWY 27,, South State Bank Building, DAVENPORT, FL, 33837, US |
| ZIP code: | 33837 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962958264 | 2016-08-28 | 2016-09-19 | 42725 HIGHWAY 27, SUITE 202, DAVENPORT, FL, 338376821, US | 42725 US-27, SUITE # 202, DAVENPORT, FL, 33837, US | |||||||||||||||||||||||
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| Phone | +1 407-808-3808 |
| Phone | +1 520-907-6833 |
Authorized person
| Name | FADY ASHAMALLA |
| Role | OWNER AND DIRECTOR |
| Phone | 4078083808 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ME117175 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI (SELF) |
| Number | 1912163866 |
| Name | Role | Address |
|---|---|---|
| ASHAMALLA FADY | Agent | 42735 US HWY 27,, DAVENPORT, FL, 33837 |
| Name | Role | Address |
|---|---|---|
| ASHAMALLA FADY | Authorized Member | 42735 US HWY 27,, DAVENPORT, FL, 33837 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-30 | 42735 US HWY 27,, South State bank Building, SUITE #202, DAVENPORT, FL 33837 | No data |
| CHANGE OF MAILING ADDRESS | 2022-01-30 | 42735 US HWY 27,, South State bank Building, SUITE #202, DAVENPORT, FL 33837 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-30 | 42735 US HWY 27,, South State bank Building, 202, DAVENPORT, FL 33837 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-23 |
| ANNUAL REPORT | 2023-01-15 |
| ANNUAL REPORT | 2022-01-30 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-03-12 |
| ANNUAL REPORT | 2017-02-12 |
| Florida Limited Liability | 2016-07-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
