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PREMIER PSYCHIATRIC AND PRIMARY HEALTHCARE LLC - Florida Company Profile

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Company Details

Entity Name: PREMIER PSYCHIATRIC AND PRIMARY HEALTHCARE LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 15 Apr 2024 (a year ago)
Document Number: L24000176237
Address: 9305 OGLETHORPE DR, GROVELAND, FL, 34736, UN
Mail Address: 9305 OGLETHORPE DR, GROVELAND, FL, 34736, UN
ZIP code: 34736
City: Groveland
County: Lake
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
JEAN-LOUIS KELLY E Authorized Representative 9305 OGLETHORPE DR, GROVELAND, FL, 34736
WILLIAMS DORIAN N Authorized Representative 5279 SHALE RIDGE TRAIL, ORLANDO, FL, 32818
JEAN-LOUIS KELLY E Agent 9305 OGLETHORPE DR, GROVELAND, FL, 34736

Unique Entity ID

Unique Entity ID:
XZ4YQDXJA538
CAGE Code:
9YL66
UEI Expiration Date:
2025-07-19

Business Information

Division Name:
PREMIER PSYCHIATRIC AND PRIMARY HEALTHCARE
Activation Date:
2024-07-23
Initial Registration Date:
2024-06-10

Commercial and government entity program

CAGE number:
9YL66
Status:
Active
Type:
Non-Manufacturer
CAGE Update Date:
2025-07-19
CAGE Expiration:
2029-07-23
SAM Expiration:
2025-07-19

Contact Information

POC:
KELLY E. JEAN-LOUIS
Corporate URL:
premierpph.com

National Provider Identifier

NPI Number:
1598557233
Certification Date:
2025-05-19

Authorized Person:

Name:
KELLY EILEEN JEAN-LOUIS
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
4079873933

Documents

Name Date
Florida Limited Liability 2024-04-15

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Date of last update: 03 Aug 2025

Sources: Florida Department of State