| Entity Name: | PRIVATE MENTAL HEALTH GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Jan 2023 (2 years ago) |
| Document Number: | L23000030220 |
| FEI/EIN Number | 922143799 |
| Address: | 3100 North Ocean Blvd, fort lauderdale, FL, 33308, US |
| Mail Address: | 3100 North Ocean Blvd, fort lauderdale, FL, 33308, US |
| ZIP code: | 33308 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | PRIVATE MENTAL HEALTH GROUP LLC, NEW YORK | 7369696 | NEW YORK |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639865678 | 2023-04-13 | 2023-04-13 | 3100 NORTH OCEAN BLVD, UNIT 603, FORT LAUDERDALE, FL, 33308, US | 12 SE 7TH STREET, SUITE 705, FORT LAUDERDALE, FL, 33301, US | |||||||||||||||||||||
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| Phone | +1 646-512-3203 |
| Fax | 7548002610 |
| Phone | +1 954-794-9000 |
Authorized person
| Name | DR. OLGA KATZ |
| Role | MEDICAL DIRECTOR |
| Phone | 9174944975 |
Taxonomy
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| FLORIDA HEALTHCARE LAW FIRM | Agent | 151 NW 1ST AVE, DELRAY BEACH, FL, 33444 |
| Name | Role | Address |
|---|---|---|
| LIVSHITS MARK | Manager | 38 WINTHROP PLACE, STATEN ISLAND, NY, 10314 |
| KATZ OLGA | Manager | 12 SE 7TH STREET, FT. LAUDERDALE, FL, 33301 |
| RABINOVICH MARINA | Manager | 12 SE 7TH STREET, FT. LAUDERDALE, FL, 33301 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-15 | 3100 North Ocean Blvd, unit 603, fort lauderdale, FL 33308 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-15 | 3100 North Ocean Blvd, unit 603, fort lauderdale, FL 33308 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-04 |
| Florida Limited Liability | 2023-01-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
