| Entity Name: | PREMIERE BEHAVIORAL SUPPORTS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 29 Nov 2021 (3 years ago) |
| Document Number: | L21000505698 |
| FEI/EIN Number | 82-2449309 |
| Address: | 291 GATEWOOD DR, LARGO, FL, 33770, FL |
| Mail Address: | 404 INDEPENDENCE BLVD, SICKLERVILLE, NJ, 08081, UN |
| ZIP code: | 33770 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710402631 | 2017-08-11 | 2022-09-15 | 404 INDEPENDENCE BLVD, SICKLERVILLE, NJ, 080811094, US | 291 GATEWOOD DR, LARGO, FL, 337702902, US | |||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 856-861-5448 |
| Fax | 8565998300 |
| Phone | +1 352-995-8861 |
Authorized person
| Name | JASON GIANSANTI |
| Role | PRESIDENT |
| Phone | 8568615448 |
Taxonomy
| Taxonomy Code | 106S00000X - Behavior Technician |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | No |
| Taxonomy Code | 372600000X - Adult Companion |
| Is Primary | No |
| Taxonomy Code | 385HR2060X - Child Intellectual and/or Developmental Disabilities Respite Care |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0588164 |
| State | NJ |
| Issuer | MEDICAID |
| Number | 114080800 |
| State | FL |
| Issuer | MEDICAID |
| Number | 115254900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GIANSANTI JASON E | Agent | 404 INDEPENDENCE BLVD, SICKLERVILLE, FL, 08081 |
| Name | Role | Address |
|---|---|---|
| GIANSANTI JASON | Authorized Member | 404 INDEPENDENCE BLVD, SICKLERVILLE, NJ, 08081 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-20 |
| ANNUAL REPORT | 2022-03-11 |
| Florida Limited Liability | 2021-11-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
