| Entity Name: | BRIGHTSOUL BEHAVIORAL & MEDICAL HEALTHCARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Feb 2022 (3 years ago) |
| Document Number: | L22000063010 |
| FEI/EIN Number | 88-0576110 |
| Address: | 6100 LAKE ELLENOR DRIVE, ORLANDO, FL, 32809, US |
| Mail Address: | 6100 LAKE ELLENOR DRIVE, ORLANDO, FL, 32809, US |
| ZIP code: | 32809 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114669991 | 2022-04-11 | 2022-05-17 | 2098 WINNETKA CT, ORLANDO, FL, 328185325, US | 6100 LAKE ELLENOR DR STE 205, ORLANDO, FL, 328094632, US | |||||||||||||||
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| Phone | +1 407-412-6652 |
| Fax | 4074126668 |
Authorized person
| Name | ESTHER LUC PELISSIER |
| Role | APRN |
| Phone | 4074126652 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PELISSIER ESTHER LUC | Agent | 2098 WINNETKA CT, ORLANDO, FL, 32818 |
| Name | Role | Address |
|---|---|---|
| PELISSIER ESTHER LUC | APRN | 2098 WINNETKA CT, ORLANDO, FL, 32818 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-05-10 | 6100 LAKE ELLENOR DRIVE, SUITE 205, ORLANDO, FL 32809 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-26 | 6100 LAKE ELLENOR DRIVE, SUITE 205, ORLANDO, FL 32809 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-06 |
| ANNUAL REPORT | 2023-04-29 |
| Florida Limited Liability | 2022-02-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
