| Entity Name: | FOUNDATIONS IN BEHAVIOR, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Jul 2016 (9 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 28 Dec 2023 (a year ago) |
| Document Number: | L16000145226 |
| FEI/EIN Number | 81-3575781 |
| Mail Address: | 7901 4th St N, STE 300, St. Petersburg, FL, 33702, US |
| Address: | 148 Wilshire Boulevard, Casselberry, FL, 32707, US |
| ZIP code: | 32707 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982145306 | 2017-03-17 | 2017-04-08 | 255 PRIMERA BLVD, SUITE 160B, LAKE MARY, FL, 327462158, US | 255 PRIMERA BLVD, SUITE 160B, LAKE MARY, FL, 327462158, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 765-776-6668 |
Authorized person
| Name | MR. LORNE THOMAS BALMER |
| Role | BEHAVIOR ANALYST/OWNER |
| Phone | 7657766668 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | 0-16-7295 |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | 1-09-5012 |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 018833200 |
| State | FL |
| Issuer | MEDICAID |
| Number | 018489600 |
| State | FL |
| Name | Role |
|---|---|
| NORTHWEST REGISTERED AGENT LLC | Agent |
| Name | Role | Address |
|---|---|---|
| Riga Richard | Auth | 7901 4th St N STE 300, St. Petersburg, FL, 33702 |
| Black Alicia | Auth | 7901 4th St N STE 300, St. Petersburg, FL, 33702 |
| Balmer Lorne | Auth | 7901 4th St N STE 300, St. Petersburg, FL, 33702 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000151908 | FOUNDATIONS IN EDUCATION | ACTIVE | 2023-12-14 | 2028-12-31 | No data | 148 WILSHIRE BOULEVARD, CASSELBERRY, FL, 32707 |
| G23000151911 | FOUNDATIONS | ACTIVE | 2023-12-14 | 2028-12-31 | No data | 148 WILSHIRE BOULEVARD, CASSELBERRY, FL, 32707 |
| G21000148056 | FOUNDATIONS IN BEHAVIOR EDUCATIONAL CENTER | ACTIVE | 2021-11-04 | 2026-12-31 | No data | 255 PRIMERA BLVD, SUITE 160B, LAKE MARY, FL, 32746 |
| G20000062453 | MAITLAND 1680 | ACTIVE | 2020-06-04 | 2025-12-31 | No data | 255 PRIMERA BLVD, SUITE 160B, LAKE MARY, FL, 32746 |
| G18000096528 | FOUNDATIONS IN BEHAVIOR | ACTIVE | 2018-08-29 | 2028-12-31 | No data | 148 WILSHIRE BOULEVARD, CASSELBERRY, FL, 32707 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-23 | 148 Wilshire Boulevard, Casselberry, FL 32707 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-23 | 148 Wilshire Boulevard, Casselberry, FL 32707 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-23 | 7901 4th St N, STE 300, St. Petersburg, FL 33702 | No data |
| LC STMNT OF RA/RO CHG | 2023-12-28 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-12-28 | NORTHWEST REGISTERED AGENT LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-23 |
| CORLCRACHG | 2023-12-28 |
| ANNUAL REPORT | 2023-05-19 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-06-09 |
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-02-20 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-03-12 |
| Florida Limited Liability | 2016-07-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
