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MFE PSYCHIATRY LLC

Company Details

Entity Name: MFE PSYCHIATRY LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 07 Jun 2018 (7 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 09 Mar 2020 (5 years ago)
Document Number: L18000141071
FEI/EIN Number 83-0888876
Address: 13801 Bruce B Downs Blvd, Tampa, FL, 33613, US
Mail Address: 13801 Bruce B Downs Blvd, Tampa, FL, 33613, US
ZIP code: 33613
County: Hillsborough
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1285256040 2020-05-14 2024-10-16 13801 BRUCE B DOWNS BLVD STE 305, TAMPA, FL, 336133939, US 13801 BRUCE B DOWNS BLVD STE 305, TAMPA, FL, 336133939, US

Contacts

Phone +1 352-519-2119

Authorized person

Name MARC ETTENSOHN
Role CEO FOUNDER
Phone 3525192119

Taxonomy

Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary Yes
Taxonomy Code 2084P0800X - Psychiatry Physician
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MFE PSYCHIATRY LLC 401(K) PLAN 2023 830888876 2024-05-14 MFE PSYCHIATRY LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-08-02
Business code 621112
Sponsor’s telephone number 3525192119
Plan sponsor’s address 410 EVERNIA ST, APT 613, WEST PALM BEACH, FL, 33401

Plan administrator’s name and address

Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of

Role Plan administrator
Date 2024-05-14
Name of individual signing QIAN LIU
Valid signature Filed with authorized/valid electronic signature
MFE PSYCHIATRY LLC 401(K) PLAN 2022 830888876 2023-05-27 MFE PSYCHIATRY LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-08-02
Business code 621112
Sponsor’s telephone number 3525192119
Plan sponsor’s address 410 EVERNIA ST, APT 613, WEST PALM BEACH, FL, 33401

Plan administrator’s name and address

Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of

Role Plan administrator
Date 2023-05-27
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
MFE PSYCHIATRY LLC 401(K) PLAN 2021 830888876 2022-06-02 MFE PSYCHIATRY LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-08-02
Business code 621112
Sponsor’s telephone number 3525192119
Plan sponsor’s address 410 EVERNIA ST, APT 613, WEST PALM BEACH, FL, 33401

Plan administrator’s name and address

Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702
Administrator’s telephone number 8882283491

Signature of

Role Plan administrator
Date 2022-06-02
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Marc Ettensohn Agent 13801 Bruce B Downs Blvd, Tampa, FL, 33613

Authorized Member

Name Role Address
ETTENSOHN MARC Authorized Member 13801 BRUCE B DOWNS BLVD, TAMPA, FL, 33613

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G21000101876 CORNERSTONE PSYCHIATRIC CARE ACTIVE 2021-08-04 2026-12-31 No data 410 EVERNIA ST, STE 613, WEST PALM BEACH, FL, 33401

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2024-03-17 13801 Bruce B Downs Blvd, ste 305, Tampa, FL 33613 No data
CHANGE OF PRINCIPAL ADDRESS 2023-09-29 13801 Bruce B Downs Blvd, Tampa, FL 33613 No data
CHANGE OF MAILING ADDRESS 2023-09-29 13801 Bruce B Downs Blvd, Tampa, FL 33613 No data
REINSTATEMENT 2020-03-09 No data No data
REGISTERED AGENT NAME CHANGED 2020-03-09 Marc Ettensohn No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2019-09-27 No data No data

Documents

Name Date
ANNUAL REPORT 2024-03-17
ANNUAL REPORT 2023-01-23
ANNUAL REPORT 2022-01-26
ANNUAL REPORT 2021-05-30
REINSTATEMENT 2020-03-09
Florida Limited Liability 2018-06-07

Date of last update: 01 Feb 2025

Sources: Florida Department of State