| Entity Name: | RIVER CITY MENTAL HEALTH COUNSELING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 30 Jul 2019 (6 years ago) |
| Document Number: | L19000194470 |
| FEI/EIN Number | 84-2552549 |
| Address: | 4711 Hwy 17 South, Bldg C Suite 4, Fleming Island, FL 32003 |
| Mail Address: | 308 MARISCO WAY, JACKSONVILLE, FL 32220 |
| ZIP code: | 32003 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518513506 | 2019-08-15 | 2019-08-15 | 308 MARISCO WAY, JACKSONVILLE, FL, 322204608, US | 4711 US HIGHWAY 17 STE 4, FLEMING ISLAND, FL, 320038211, US | |||||||||||||||||||||
|
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| Phone | +1 904-465-1275 |
| Fax | 9044858359 |
Authorized person
| Name | MR. MICHAEL BRENT WADE JR. |
| Role | OWNER |
| Phone | 9044651275 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 007650300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WADE, MICHAEL B, JR | Agent | 308 MARISCO WAY, JACKSONVILLE, FL 32220 |
| Name | Role | Address |
|---|---|---|
| WADE, MICHAEL B, JR | Manager | 308 MARISCO WAY, JACKSONVILLE, FL 32220 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-05-27 | 4711 Hwy 17 South, Bldg C Suite 4, Fleming Island, FL 32003 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-04-19 |
| ANNUAL REPORT | 2021-02-09 |
| ANNUAL REPORT | 2020-05-27 |
| Florida Limited Liability | 2019-07-30 |
Date of last update: 16 Feb 2025
Sources: Florida Department of State
