| Entity Name: | MENDOZA BEHAVIORAL HEALTH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 03 Apr 2017 (8 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | L17000073897 |
| FEI/EIN Number | 82-1197096 |
| Address: | 140 S. BEACH STREET,, SUITE 402, DAYTONA BEACH, FL, 32114, US |
| Mail Address: | 210 S BEACH STREET, DAYTONA BEACH, FL, 32114, US |
| ZIP code: | 32114 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295262137 | 2017-05-22 | 2019-06-11 | 110 ORANGE AVE, DAYTONA BEACH, FL, 321144310, US | 110 ORANGE AVE, DAYTONA BEACH, FL, 321144310, US | |||||||||||||||||||||||
|
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| Phone | +1 386-256-4326 |
Authorized person
| Name | LIANA MENDOZA |
| Role | PSYCHIATRIST |
| Phone | 3862542637 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ACN216 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 280152300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MENDOZA LIANA MD | Agent | 210 S BEACH STREET, DAYTONA BEACH, FL, 32114 |
| Name | Role | Address |
|---|---|---|
| LIANA MENDOZA M.D | Manager | 210 S BEACH STREET, DAYTONA BEACH, FL, 32114 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| LC DISSOCIATION MEM | 2018-10-15 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-10-03 | 140 S. BEACH STREET,, SUITE 402, DAYTONA BEACH, FL 32114 | No data |
| CHANGE OF MAILING ADDRESS | 2018-10-03 | 140 S. BEACH STREET,, SUITE 402, DAYTONA BEACH, FL 32114 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-10-03 | MENDOZA, LIANA, MD | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-10-03 | 210 S BEACH STREET, SUITE 202, DAYTONA BEACH, FL 32114 | No data |
| REINSTATEMENT | 2018-10-03 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| Name | Date |
|---|---|
| CORLCDSMEM | 2018-10-15 |
| REINSTATEMENT | 2018-10-03 |
| Florida Limited Liability | 2017-04-03 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
