| Entity Name: | BOCA RATON PSYCHIATRY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Feb 2017 (8 years ago) |
| Document Number: | L17000043268 |
| FEI/EIN Number | 82-0631717 |
| Address: | 9980 N Central Park Blvd, Suite 210, Boca Raton, FL, 33428, US |
| Mail Address: | 9980 N Central Park Blvd, Suite 210, Boca Raton, FL, 33428, US |
| ZIP code: | 33428 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275056616 | 2017-07-18 | 2019-09-03 | 7887 BLUE SAGE WAY, PARKLAND, FL, 330764450, US | 9980 CENTRAL PARK BLVD N STE 210, BOCA RATON, FL, 334281703, US | |||||||||||||||||||||||
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| Phone | +1 561-342-8822 |
| Fax | 5613428985 |
Authorized person
| Name | DR. RICHARD CANNON PHELPS |
| Role | OWNER/PSYCHIATRIST |
| Phone | 8438702779 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | OS12896 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | TYPE 1 NPI |
| Number | 1942490016 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BOCA RATON PSYCHIATRY, LLC 401 (K) PLAN | 2023 | 820631717 | 2024-07-11 | BOCA RATON PSYCHIATRY, LLC | 16 | |||||||||||||
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| BOCA RATON PSYCHIATRY, LLC 401 (K) PLAN | 2022 | 820631717 | 2023-07-18 | BOCA RATON PSYCHIATRY, LLC | 10 | |||||||||||||
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| BOCA RATON PSYCHIATRY, LLC 401 (K) PLAN | 2021 | 820631717 | 2022-07-19 | BOCA RATON PSYCHIATRY, LLC | 7 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| DAVID M BECKERMAN PA | Agent | 7000 WEST PALMETTO PARK ROAD, BOCA RATON, FL, 33433 |
| Name | Role | Address |
|---|---|---|
| PHELPS RICHARD | Manager | 9980 N Central Park Blvd, Boca Raton, FL, 33428 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-07-03 | 9980 N Central Park Blvd, Suite 210, Boca Raton, FL 33428 | No data |
| CHANGE OF MAILING ADDRESS | 2024-07-03 | 9980 N Central Park Blvd, Suite 210, Boca Raton, FL 33428 | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-07-29 |
| AMENDED ANNUAL REPORT | 2024-07-03 |
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-22 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-08 |
| ANNUAL REPORT | 2020-02-05 |
| ANNUAL REPORT | 2019-03-08 |
| ANNUAL REPORT | 2018-01-15 |
| Florida Limited Liability | 2017-02-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
