| Entity Name: | LAKE BEHAVIORAL HEALTH MANAGEMENT LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 05 Apr 2017 (8 years ago) |
| Document Number: | L17000077083 |
| FEI/EIN Number | 82-1214623 |
| Address: | 225 WEST CANTON, SUITE 600, WINTER PARK, FL 32789 UN |
| Mail Address: | 225 WEST CANTON, SUITE 600, WINTER PARK, FL 32789 UN |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | LAKE BEHAVIORAL HEALTH MANAGEMENT LLC, KENTUCKY | 1159206 | KENTUCKY |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356811897 | 2018-11-27 | 2018-11-27 | 225 W CANTON AVE STE 600, WINTER PARK, FL, 327893181, US | 225 W CANTON AVE STE 600, WINTER PARK, FL, 327893181, US | |||||||||||||||||
|
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| Phone | +1 407-622-8086 |
Authorized person
| Name | DAVID CORDDRY |
| Role | OWNER |
| Phone | 4076228086 |
Taxonomy
| Taxonomy Code | 207RG0300X - Geriatric Medicine (Internal Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0805X - Geriatric Psychiatry Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CORDDRY, DAVID | Agent | 225 WEST CANTON AVE, SUITE 600, WINTER PARK, FL 32789 |
| Name | Role | Address |
|---|---|---|
| CORDDRY, DAVID | Manager | 225 WEST CANTON SUITE 600, WINTER PARK, FL 32789 UN |
| CORDDRY, MICHAEL | Manager | 225 WEST CANTON SUITE 600, WINTER PARK, FL 32789 UN |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-02-08 |
| ANNUAL REPORT | 2020-04-30 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-01-24 |
| Florida Limited Liability | 2017-04-05 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
