| Entity Name: | FRIAR PSYCHIATRIC SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Oct 2021 (3 years ago) |
| Document Number: | L21000454411 |
| FEI/EIN Number | 87-3174404 |
| Address: | 11968 balm riverview rd, RIVERVIEW, FL, 33569, US |
| Mail Address: | 11968 balm riverview rd, RIVERVIEW, FL, 33569, US |
| ZIP code: | 33569 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740947928 | 2021-11-22 | 2024-01-31 | 11412 ACACIA GROVE LN, RIVERVIEW, FL, 335798412, US | 11968 BALM RIVERVIEW RD, RIVERVIEW, FL, 335696601, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 386-299-0045 |
| Phone | +1 813-819-3335 |
| Fax | 8668851512 |
Authorized person
| Name | TREVON JARROD FRIAR |
| Role | OWNER |
| Phone | 3862990045 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| 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 | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 112746000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FRIAR TREVON | Agent | 11968 balm riverview rd, RIVERVIEW, FL, 33569 |
| Name | Role | Address |
|---|---|---|
| FRIAR TREVON | Manager | 11968 balm riverview rd, RIVERVIEW, FL, 33569 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000068420 | PIVOTING MINDS PSYCHIATRY | ACTIVE | 2022-06-03 | 2027-12-31 | No data | 11412 ACACIA GROVE LN, RIVERVIEW, FL, 33579 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-30 | 11968 balm riverview rd, RIVERVIEW, FL 33569 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-30 | 11968 balm riverview rd, RIVERVIEW, FL 33569 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-30 | 11968 balm riverview rd, RIVERVIEW, FL 33569 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-17 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-04-25 |
| Florida Limited Liability | 2021-10-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
