| Entity Name: | GENICS BEHAVIORAL HEALTH PSYCHIATRY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Jan 2024 (a year ago) |
| Document Number: | L24000001221 |
| Address: | 3051 SANDPIPER BAY CIR, NAPLES, FL, 34112, US |
| Mail Address: | 8891 Brighton Lane, BONITA SPRINGS, FL, 34135, US |
| ZIP code: | 34112 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093560583 | 2024-04-18 | 2024-04-18 | 8891 BRIGHTON LN STE 108, BONITA SPRINGS, FL, 341357526, US | 8891 BRIGHTON LN STE 108, BONITA SPRINGS, FL, 341357526, US | |||||||||||||
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| Phone | +1 954-417-5895 |
Authorized person
| Name | MR. WATSON CAMILUS |
| Role | PMHNP |
| Phone | 9544175895 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CAMILUS WATSON | Agent | 3051 SANDPIPER BAY CIR # 1205, NAPLES, FL, 34112 |
| Name | Role | Address |
|---|---|---|
| CAMILUS WATSON | Authorized Member | 3051 SANDPIPER BAY CIR # 1205, NAPLES, FL, 34112 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-05-17 | 3051 SANDPIPER BAY CIR, Apt. I-205, NAPLES, FL 34112 | No data |
| CHANGE OF MAILING ADDRESS | 2024-05-17 | 3051 SANDPIPER BAY CIR, Apt. I-205, NAPLES, FL 34112 | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-01-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
