| Entity Name: | COMMUNITY BEHAVIORAL HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 31 Jan 2019 (6 years ago) |
| Document Number: | L19000032093 |
| FEI/EIN Number | 83-3550941 |
| Address: | 3501 Del Prado Blvd S, CAPE CORAL, FL, 33904, US |
| Mail Address: | 3501 Del Prado Blvd S, CAPE CORAL, FL, 33904, US |
| ZIP code: | 33904 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649733544 | 2019-04-09 | 2024-01-25 | 3501 DEL PRADO BLVD S STE 303, CAPE CORAL, FL, 339047222, US | 3501 DEL PRADO BLVD S STE 303, CAPE CORAL, FL, 339047222, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 239-424-3346 |
| Fax | 2396737681 |
| Phone | +1 239-317-0265 |
Authorized person
| Name | MIGUEL A DIAZ |
| Role | OWNER |
| Phone | 2394643310 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 2084A0401X - Addiction Medicine (Psychiatry & Neurology) Physician |
| Is Primary | No |
| Taxonomy Code | 2084B0040X - Behavioral Neurology & Neuropsychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0802X - Addiction Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0805X - Geriatric Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084S0012X - Sleep Medicine (Psychiatry & Neurology) Physician |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 103311900 |
| State | FL |
| Issuer | MEDICAID |
| Number | 103311901 |
| State | FL |
| Issuer | BLUE CROSS |
| Number | 3FBY8 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DIAZ MIGUEL A | Agent | 2701 SW 110 AVE, MIAMI, FL, 33165 |
| Name | Role | Address |
|---|---|---|
| DIAZ MIGUEL A | President | 2701 SW 110 AVE, MIAMI, FL, 33165 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-18 | 2701 SW 110 AVE, MIAMI, FL 33165 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-02-18 | 3501 Del Prado Blvd S, Suite 303, CAPE CORAL, FL 33904 | No data |
| CHANGE OF MAILING ADDRESS | 2020-02-18 | 3501 Del Prado Blvd S, Suite 303, CAPE CORAL, FL 33904 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-18 |
| ANNUAL REPORT | 2023-03-06 |
| AMENDED ANNUAL REPORT | 2022-03-04 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-02-18 |
| Florida Limited Liability | 2019-01-31 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
