| Entity Name: | BLUESTONE PSYCHIATRY, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Mar 2020 (5 years ago) |
| Document Number: | L20000088486 |
| FEI/EIN Number | 85-0536870 |
| Address: | 5664 Bee Ridge Rd., Sarasota, FL, 34233, US |
| Mail Address: | 5664 Bee Ridge Rd., Sarasota, FL, 34233, US |
| ZIP code: | 34233 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700563053 | 2023-06-29 | 2023-07-05 | 5664 BEE RIDGE RD STE 203, SARASOTA, FL, 342331504, US | 5664 BEE RIDGE RD STE 203, SARASOTA, FL, 342331504, US | |||||||||||||
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| Phone | +1 877-422-9355 |
Authorized person
| Name | JORDANA HOLLEN |
| Role | CO-OWNER |
| Phone | 8774229355 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BLUESTONE PSYCHIATRY 401(K) PLAN & TRUST | 2022 | 850536870 | 2024-02-13 | BLUESTONE PSYCHIATRY, PLLC | 3 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-02-13 |
| Name of individual signing | MARK D'AGOSTINO M.D. |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621112 |
| Sponsor’s telephone number | 8774229355 |
| Plan sponsor’s address | 5664 BEE RIDGE ROAD, SUITE 203, SARASOTA, FL, 342331504 |
Signature of
| Role | Plan administrator |
| Date | 2023-02-14 |
| Name of individual signing | MARK D'AGOSTINO M.D. |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621112 |
| Sponsor’s telephone number | 8774229355 |
| Plan sponsor’s address | 5664 BEE RIDGE ROAD, SUITE 203, SARASOTA, FL, 342331504 |
Signature of
| Role | Plan administrator |
| Date | 2021-10-15 |
| Name of individual signing | MARK D'AGOSTINO M.D. |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621112 |
| Sponsor’s telephone number | 8774229355 |
| Plan sponsor’s address | 5664 BEE RIDGE ROAD, SUITE 203, SARASOTA, FL, 342331504 |
Signature of
| Role | Plan administrator |
| Date | 2023-02-14 |
| Name of individual signing | MARK D'AGOSTINO M.D. |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| GOMEZ-CUETARA FLORENCIO NIV | Agent | 5664 Bee Ridge Rd., Sarasota, FL, 34233 |
| Name | Role | Address |
|---|---|---|
| HOLLEN JORDANA WDR. | Manager | 5664 Bee Ridge Rd., Sarasota, FL, 34233 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-05-08 | 5664 Bee Ridge Rd., Suite 203, Sarasota, FL 34233 | No data |
| CHANGE OF MAILING ADDRESS | 2021-05-08 | 5664 Bee Ridge Rd., Suite 203, Sarasota, FL 34233 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-05-08 | 5664 Bee Ridge Rd., Suite 203, Sarasota, FL 34233 | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-08-29 |
| ANNUAL REPORT | 2024-01-20 |
| ANNUAL REPORT | 2023-01-15 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-05-08 |
| Florida Limited Liability | 2020-03-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
