| Entity Name: | EVOLUTION PSYCHIATRIC AND MENTAL HEALTH SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Jul 2021 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 29 Jul 2022 (3 years ago) |
| Document Number: | L21000305524 |
| FEI/EIN Number | 87-1658233 |
| Address: | 1204 NW 69th Ter, GAINESVILLE, FL, 32605, US |
| Mail Address: | 1204 NW 69th Ter, GAINESVILLE, FL, 32605, US |
| ZIP code: | 32605 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972262699 | 2021-12-09 | 2024-01-28 | 1204 NW 69TH TER STE B, GAINESVILLE, FL, 326053139, US | 1204 NW 69TH TER STE B, GAINESVILLE, FL, 326053139, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 352-575-3600 |
| Fax | 3525590495 |
| Fax | 3526419592 |
Authorized person
| Name | AIJAY RICHARDS |
| Role | PMHNP |
| Phone | 3525753600 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| RICHARDS AIJAY | Agent | 1204 NW 69th Ter, GAINESVILLE, FL, 32605 |
| Name | Role | Address |
|---|---|---|
| Richards Aijay | Chief Executive Officer | 1204 NW 69th Ter., GAINESVILLE, FL, 32605 |
| Name | Role | Address |
|---|---|---|
| Fulks Dallas | Manager | 1204 NW 69th Ter, GAINESVILLE, FL, 32605 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000057654 | EVOLUTION HEALTH | ACTIVE | 2023-05-07 | 2028-12-31 | No data | 1204 NW 69TH TER, STE B, GAINESVILLE, FL, 32605 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-07-05 | 1204 NW 69th Ter, Ste B, GAINESVILLE, FL 32605 | No data |
| CHANGE OF MAILING ADDRESS | 2023-07-05 | 1204 NW 69th Ter, Ste B, GAINESVILLE, FL 32605 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-07-05 | 1204 NW 69th Ter, Ste B, GAINESVILLE, FL 32605 | No data |
| LC AMENDMENT | 2022-07-29 | No data | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-11-15 |
| ANNUAL REPORT | 2024-02-21 |
| AMENDED ANNUAL REPORT | 2023-07-20 |
| ANNUAL REPORT | 2023-07-05 |
| LC Amendment | 2022-07-29 |
| ANNUAL REPORT | 2022-04-28 |
| Florida Limited Liability | 2021-07-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
