| Entity Name: | CENTER FOR CHILD AND ADULT PSYCHIATRY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Jan 2019 (6 years ago) |
| Document Number: | L19000023660 |
| FEI/EIN Number | 83-3390019 |
| Address: | 3975 MORAN ROAD, TAMPA, FL, 33618, US |
| Mail Address: | 3975 MORAN ROAD, TAMPA, FL, 33618, US |
| ZIP code: | 33618 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861950420 | 2019-03-03 | 2019-03-03 | 1911 MONONGAHELA AVE UNIT 82661, PITTSBURGH, PA, 152186616, US | 2909 W BAY TO BAY BLVD STE 210, TAMPA, FL, 336298100, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 330-632-0173 |
| Phone | +1 813-995-1775 |
Authorized person
| Name | GREGORY THORKELSON |
| Role | PRESIDENT |
| Phone | 3306320172 |
Taxonomy
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NATIONAL PLAN & PROVIDER ENUMERATION SYSTEM |
| Number | 1295225597 |
| Name | Role |
|---|---|
| APEX FINANCIAL SOLUTIONS, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| THORKELSON GREGORY | Authorized Member | 5725 FORWARD AVENUE, SUITE 401, PITTSBURGH, PA, 15217 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-29 | 3975 MORAN ROAD, TAMPA, FL 33618 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-29 | 3975 MORAN ROAD, TAMPA, FL 33618 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-04-29 | APEX FINANCIAL SOLUTIONS | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-29 | 3975 MORAN ROAD, TAMPA, FL 33618 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-03-03 |
| ANNUAL REPORT | 2020-05-09 |
| Florida Limited Liability | 2019-01-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
