| Entity Name: | MENTAL HEALTH JAX, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Sep 2017 (7 years ago) |
| Document Number: | L17000195535 |
| FEI/EIN Number | 82-2859128 |
| Address: | 16927 ETHEL ROAD, JACKSONVILLE, FL, 32218, US |
| Mail Address: | 16927 ETHEL ROAD, JACKSONVILLE, FL, 32218, US |
| ZIP code: | 32218 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780193094 | 2017-09-29 | 2017-09-29 | 16927 ETHEL RD, JACKSONVILLE, FL, 322181107, US | 8825 PERIMETER PARK BLVD, JACKSONVILLE, FL, 322161108, US | |||||||||||||||||||||||
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| Phone | +1 904-860-8749 |
Authorized person
| Name | MARGARET M GHEE |
| Role | OWNER |
| Phone | 9048608749 |
Taxonomy
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| License Number | MH5145 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1639203722 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GHEE MARGARET | Agent | 16927 ETHEL ROAD, JACKSONVILLE, FL, 32218 |
| Name | Role | Address |
|---|---|---|
| GHEE MARGARET | Authorized Member | 16927 ETHEL ROAD, JACKSONVILLE, FL, 32218 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-27 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-03-19 |
| ANNUAL REPORT | 2020-02-04 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-04-28 |
| Florida Limited Liability | 2017-09-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
