| Entity Name: | PHOENIX BEHAVIORAL GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 15 Feb 2023 (2 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 05 Apr 2023 (2 years ago) |
| Document Number: | L23000083011 |
| FEI/EIN Number | 92-3918650 |
| Address: | 4949 TAMIAMI TRAIL N, STE 202, NAPLES, FL 34103 |
| Mail Address: | 4949 TAMIAMI TRAIL N, STE 202, NAPLES, FL 34103 |
| ZIP code: | 34103 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902673031 | 2023-12-08 | 2023-12-21 | 4949 TAMIAMI TRL N STE 202, NAPLES, FL, 341033017, US | 4949 TAMIAMI TRL N STE 202, NAPLES, FL, 341033017, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 239-259-1659 |
| Fax | 2396928264 |
Authorized person
| Name | JOHANNY ORTIZ |
| Role | MBR |
| Phone | 2392769464 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ORTIZ, JOHANNY | Agent | 220 9TH ST SW, NAPLES, FL 34117 |
| Name | Role | Address |
|---|---|---|
| ORTIZ, JOHANNY | Manager | 4949 TAMIAMI TRAIL N, STE 202, NAPLES, FL 34103 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-08 | 4949 TAMIAMI TRAIL N, STE 202, NAPLES, FL 34103 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-08 | 4949 TAMIAMI TRAIL N, STE 202, NAPLES, FL 34103 | No data |
| LC NAME CHANGE | 2023-04-05 | PHOENIX BEHAVIORAL GROUP LLC *** SEE NOTE *** | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| LC Name Change | 2023-04-05 |
| Florida Limited Liability | 2023-02-15 |
Date of last update: 10 Jan 2025
Sources: Florida Department of State
