| Entity Name: | LIGHTHOUSE BEHAVIORAL HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Company
LIGHTHOUSE BEHAVIORAL HEALTH, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 20 Jan 2017 (8 years ago) |
| Document Number: | L17000015838 |
| FEI/EIN Number |
81-5090670
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 533 N. NOVA ROAD, SUITE 112, ORMOND BEACH, FL 32174 |
| Mail Address: | 533 N. NOVA ROAD, SUITE 112, ORMOND BEACH, FL 32174 |
| ZIP code: | 32174 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609316959 | 2017-03-06 | 2024-10-01 | 533 N NOVA RD STE 112, ORMOND BEACH, FL, 321744420, US | 533 N NOVA RD STE 112, ORMOND BEACH, FL, 321744420, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 386-492-9041 |
| Fax | 3864929061 |
Authorized person
| Name | COURTNEY MAHAIRAS |
| Role | PRESIDENT/CLINICAL DIRECTOR |
| Phone | 3864929041 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 104796400 |
| State | FL |
| Issuer | MEDICAID |
| Number | 104313500 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LIGHTHOUSE BEHAVIORAL HEALTH 401(K) PLAN | 2023 | 815090670 | 2024-05-22 | LIGHTHOUSE BEHAVIORAL HEALTH LLC | 13 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-05-22 |
| Name of individual signing | DEMETRIOS MAHAIRAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MAHAIRAS, DEMETRIOS G | Agent | 15 PRAIRIEVIEW LANE, ORMOND BEACH, FL 32174 |
| MAHAIRAS, COURTNEY | Manager | 15 PRAIRIEVIEW LANE, ORMOND BEACH, FL 32174 |
| MAHAIRAS, DEMETRIOS | Manager | 15 PRAIRIEVIEW LANE, ORMOND BEACH, FL 32174 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2025-02-10 | 533 N. NOVA ROAD, SUITE 112, ORMOND BEACH, FL 32174 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-04 | 533 N. NOVA ROAD, SUITE 112, ORMOND BEACH, FL 32174 | - |
| REGISTERED AGENT NAME CHANGED | 2018-04-11 | MAHAIRAS, DEMETRIOS G | - |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-11 | 15 PRAIRIEVIEW LANE, ORMOND BEACH, FL 32174 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-10 |
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-02-01 |
| ANNUAL REPORT | 2022-01-04 |
| ANNUAL REPORT | 2021-03-22 |
| ANNUAL REPORT | 2020-03-25 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-04-11 |
| Florida Limited Liability | 2017-01-20 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 4542107700 | 2020-05-01 | 0491 | PPP | 595 N NOVA ROAD SUITE 119, ORMOND BEACH, FL, 32174 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 18 Feb 2025
Sources: Florida Department of State
