| Entity Name: | PHOENIX RISING PSYCHOTHERAPY CENTER PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 13 Nov 2019 (5 years ago) |
| Document Number: | L19000282416 |
| FEI/EIN Number | 84-3661786 |
| Mail Address: | 980 North Federal Highway, Suite 110, Boca Raton, FL 33432 |
| Address: | 980 NORTH FEDERAL HWY, SUITE 110, Boca Raton, FL 33432 |
| ZIP code: | 33432 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760029623 | 2019-12-10 | 2020-06-11 | 4060 ROYAL PALM BEACH BLVD, WEST PALM BEACH, FL, 334119165, US | 816 W CANAL ST S, BELLE GLADE, FL, 334302942, US | |||||||||||||||||
|
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| Phone | +1 561-502-1500 |
Authorized person
| Name | RAQUEL LUMIA |
| Role | OWNER |
| Phone | 5615021500 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 261QD1600X - Developmental Disabilities Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LUMIA, RAQUEL CHARLES | Agent | 7109 NW 78 Ave, Tamarac, FL 33321 |
| Name | Role | Address |
|---|---|---|
| Lumia, Raquel CHARLES | Manager | 980 North Federal Highway, Suite 110 Boca Raton, FL 33432 |
| Name | Role | Address |
|---|---|---|
| Poillucci, Richard, Jr. | Office Manager | 980 NORTH FEDERAL HWY, SUITE 110 Boca Raton, FL 33432 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000032278 | RAQUEL LUMIA L.M.H.C | ACTIVE | 2020-03-14 | 2025-12-31 | No data | 4060 ROYAL PALM BEACH BLVD.,, WEST PALM BEACH, FL, 33411-9103 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-29 | 980 NORTH FEDERAL HWY, SUITE 110, Boca Raton, FL 33432 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-29 | 7109 NW 78 Ave, Tamarac, FL 33321 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-29 | 980 NORTH FEDERAL HWY, SUITE 110, Boca Raton, FL 33432 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-04-08 | LUMIA, RAQUEL CHARLES | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-08 |
| AMENDED ANNUAL REPORT | 2020-12-18 |
| ANNUAL REPORT | 2020-03-14 |
| Florida Limited Liability | 2019-11-13 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
