| Entity Name: | BLUE LILY PSYCHIATRY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Oct 2021 (3 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 08 Sep 2023 (a year ago) |
| Document Number: | L21000445445 |
| FEI/EIN Number | 873079627 |
| Mail Address: | 4214 NW 38TH DR, COCONUT CREEK, FL, 33073, US |
| Address: | 1451 W CYPRESS CREEK RD #300, FT LAUDERDALE, FL, 33309, US |
| ZIP code: | 33309 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588357677 | 2023-06-02 | 2023-09-12 | 4214 NW 38TH DR, COCONUT CREEK, FL, 330734473, US | 1451 W CYPRESS CREEK RD STE 300, FORT LAUDERDALE, FL, 333091953, US | |||||||||||||||
|
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| Phone | +1 954-682-2132 |
| Phone | +1 954-477-8023 |
Authorized person
| Name | DENAYER MUELLER |
| Role | OWNER, PMHNP |
| Phone | 9544778023 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MUELLER DENAYER | Agent | 4214 NW 38TH DR, COCONUT CREEK, FL, 33073 |
| Name | Role | Address |
|---|---|---|
| CASTILLO CARLOS | Authorized Representative | 4214 NW 38TH DR, COCONUT CREEK, IL, 33073 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC NAME CHANGE | 2023-09-08 | BLUE LILY PSYCHIATRY, LLC | No data |
| LC STMNT CORR/NC | 2021-12-06 | LOTUS PSYCHIATRY GROUP, "LLC" | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-10-21 | 1451 W CYPRESS CREEK RD #300, FT LAUDERDALE, FL 33309 | No data |
| CHANGE OF MAILING ADDRESS | 2021-10-14 | 1451 W CYPRESS CREEK RD #300, FT LAUDERDALE, FL 33309 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-15 |
| LC Name Change | 2023-09-08 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-21 |
| CORLCSTCNC | 2021-12-06 |
| Florida Limited Liability | 2021-10-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
