| Entity Name: | FAMILY CARE MENTAL HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 18 Dec 2020 (4 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | L20000395603 |
| FEI/EIN Number | 85-4347234 |
| Mail Address: | 13919 BRIARDALE LN, TAMPA, FL, 33618 |
| Address: | 9340 N FLORIDA AVE, STE F, TAMPA, FL, 33612 |
| ZIP code: | 33612 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487242483 | 2021-01-05 | 2021-04-04 | 13919 BRIARDALE LN, TAMPA, FL, 336182115, US | 9340 N FLORIDA AVE STE F, TAMPA, FL, 336127925, US | |||||||||||||||||||
|
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| Phone | +1 813-703-0016 |
Authorized person
| Name | JAVIER VALDES BANGUELA |
| Role | OWNER |
| Phone | 8137030016 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 109316300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VALDES BANGUELA JAVIER | Agent | 13919 BRIARDALE LN, TAMPA, FL, 33618 |
| Name | Role | Address |
|---|---|---|
| VALDES BANGUELA JAVIER | Manager | 9340 N FLORIDA AVE STE F, TAMPA, FL, 33612 |
| VALDES ELIZABETH | Manager | 9340 N FLORIDA AVE STE F, TAMPA, FL, 33612 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-02-04 |
| Florida Limited Liability | 2020-12-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
