| Entity Name: | TAMPA BAY MENTAL HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Feb 2021 (4 years ago) |
| Document Number: | L21000062875 |
| FEI/EIN Number | 861892983 |
| Address: | 6916 W LINEBAUGH AVE SUITE, 102, TAMPA, FL, 33625, US |
| Mail Address: | 6916 W LINEBAUGH AVE SUITE 102, 102, TAMPA, FL, 33625, US |
| ZIP code: | 33625 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710570734 | 2021-02-19 | 2024-06-19 | 6916 W LINEBAUGH AVE STE 102, TAMPA, FL, 336255815, US | 6916 W LINEBAUGH AVE STE 102, TAMPA, FL, 336255815, US | |||||||||||||||||||||||||||||||
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| Phone | +1 813-269-2920 |
| Fax | 8132692921 |
Authorized person
| Name | ALAIN SANTOS PEREZ |
| Role | OWNER |
| Phone | 8132692920 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 261QC1500X - Community Health Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 109622100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 109622101 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SANTOS PEREZ ALAIN | Agent | 6916 W LINEBAUGH AVE, TAMPA, FL, 33625 |
| Name | Role | Address |
|---|---|---|
| SANTOS PEREZ ALAIN | President | 6916 W LINEBAUGH AVE SUITE 102, TAMPA, FL, 33625 |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ LEDESMA ENRIQUE | Vice President | 6916 W LINEBAUGH AVE SUITE 102, TAMPA, FL, 33625 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-09 | 6916 W LINEBAUGH AVE SUITE, 102, TAMPA, FL 33625 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-03-09 | SANTOS PEREZ, ALAIN | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-03-09 |
| Florida Limited Liability | 2021-02-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
