| Entity Name: | AMPLAA BEHAVIORAL HEALTH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Aug 2021 (4 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 31 Oct 2023 (a year ago) |
| Document Number: | L21000350591 |
| FEI/EIN Number | 87-2057497 |
| Address: | 1895 KINGSLEY AVE, SUITE #403, ORANGE PARK, FL, 32073, US |
| Mail Address: | 1895 KINGSLEY AVE, SUITE #403, ORANGE PARK, FL, 32073, US |
| ZIP code: | 32073 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639848450 | 2021-09-07 | 2021-09-08 | 1895 KINGSLEY AVE STE 403, ORANGE PARK, FL, 320734453, US | 1895 KINGSLEY AVE STE 403, ORANGE PARK, FL, 320734453, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 904-300-4341 |
Authorized person
| Name | MR. GERRY LEE SURRENCY |
| Role | OWNER |
| Phone | 9043004341 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role |
|---|---|
| LEGALCORP SOLUTIONS, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| SURRENCY GERRY | Authorized Member | 1895 KINGSLEY AVE, SUITE #403, ORANGE PARK, FL, 32073 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2023-10-31 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-10-31 | LEGALCORP SOLUTIONS, LLC | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| REINSTATEMENT | 2023-10-31 |
| ANNUAL REPORT | 2022-07-25 |
| Florida Limited Liability | 2021-08-04 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
