| Entity Name: | EXCELLENCE HEALTH PSYCHIATRY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 01 Oct 2019 (5 years ago) |
| Document Number: | L19000247094 |
| FEI/EIN Number | 84-3546953 |
| Address: | 1630 MASON AVE, SUITE C, DAYTONA BEACH, FL, 32117 |
| Mail Address: | 1630 MASON AVE, SUITE C, DAYTONA BEACH, FL, 32117 |
| ZIP code: | 32117 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619511763 | 2019-11-01 | 2019-11-01 | 1630 MASON AVE STE C, DAYTONA BEACH, FL, 321174503, US | 1630 MASON AVE STE C, DAYTONA BEACH, FL, 321174503, US | |||||||||||||
|
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| Phone | +1 386-238-9064 |
Authorized person
| Name | HUSAM EDDIN |
| Role | CMO |
| Phone | 3862389064 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| EDDIN HUSAM | Agent | 1630 MASON AVE, DAYTONA BEACH, FL, 32117 |
| Name | Role | Address |
|---|---|---|
| EDDIN HUSAM | Manager | 1630 MASON AVE, SUITE C, DAYTONA BEACH, FL, 32117 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-02-03 |
| ANNUAL REPORT | 2022-04-06 |
| ANNUAL REPORT | 2021-02-25 |
| ANNUAL REPORT | 2020-03-19 |
| Florida Limited Liability | 2019-10-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
