| Entity Name: | BEHAVIOR 180, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Feb 2019 (6 years ago) |
| Document Number: | L19000057095 |
| FEI/EIN Number | 83-3739221 |
| Address: | 420 E S.R. 434, Longwood, FL, 32750, US |
| Mail Address: | 420 E. Sr 434, Suite A, Longwood, FL, 32750, US |
| ZIP code: | 32750 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902365638 | 2019-03-12 | 2020-12-02 | 420 E SR 434 STE A, LONGWOOD, FL, 327505244, US | 420 E SR 434 STE A, LONGWOOD, FL, 327505244, US | |||||||||||||||||||||||||
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| Phone | +1 407-476-4908 |
| Fax | 8448395839 |
Authorized person
| Name | KIMMESHA C TROUTMAN |
| Role | OWNER |
| Phone | 4074764908 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
| Taxonomy Code | 106S00000X - Behavior Technician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 017645000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TROUTMAN KIMMESHA C | Agent | 1205 S. SCOTT AVE, SANFORD, FL, 32771 |
| Name | Role | Address |
|---|---|---|
| TROUTMAN KIMMESHA C | Authorized Member | 420 E S.R. 434, Longwood, FL, 32750 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-30 | 420 E S.R. 434, STE A, Longwood, FL 32750 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-15 | 420 E S.R. 434, STE A, Longwood, FL 32750 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-07 |
| ANNUAL REPORT | 2022-03-31 |
| ANNUAL REPORT | 2021-03-17 |
| ANNUAL REPORT | 2020-05-07 |
| Florida Limited Liability | 2019-02-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
