Entity Name: | PSHS ALPHA PARTNERS, LLC |
Jurisdiction: | FLORIDA |
Filing Type: | Florida Limited Liability Co. |
Status: | Active |
Date Filed: | 01 May 2024 (9 months ago) |
Last Event: | CONVERSION |
Event Date Filed: | 01 May 2024 (9 months ago) |
Document Number: | L24000196932 |
FEI/EIN Number | 650793962 |
Mail Address: | 340 Seven Springs Way, Brentwood, TN, 37027, US |
Address: | 7408 Lake Worth Rd, Lake Worth, FL, 33467, US |
ZIP code: | 33467 |
County: | Palm Beach |
Place of Formation: | FLORIDA |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1033106612 | 2005-09-29 | 2024-05-09 | 7408 LAKE WORTH RD STE 900, LAKE WORTH, FL, 334672502, US | 7408 LAKE WORTH RD STE 900, LAKE WORTH, FL, 334672502, US | |||||||||||||||||||||||||||||||||||||
|
Phone | +1 561-433-5700 |
Fax | 5614335901 |
Authorized person
Name | JENNIFER B. BALDOCK |
Role | OFFICER AND AUTHORIZED OFFICIAL |
Phone | 6152345954 |
Taxonomy
Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
License Number | 1069 |
State | FL |
Is Primary | Yes |
Other Provider Identifiers
Issuer | US DEPT OF LABOR |
Number | 170233100 |
State | FL |
Issuer | MEDICAID |
Number | 0705721-00 |
State | FL |
Issuer | BLUE CROSS BLUE SHIELD |
Number | 67G |
State | FL |
Name | Role |
---|---|
CORPORATION SERVICE COMPANY | Agent |
Name | Role | Address |
---|---|---|
BALDOCK JENNIFER | Authorized Member | 340 SEVEN SPRINGS WAY SUITE 600, BRENTWOOD, TN, 37027 |
Event Type | Filed Date | Value | Description |
---|---|---|---|
CHANGE OF PRINCIPAL ADDRESS | 2024-05-13 | 7408 Lake Worth Rd, Suite 900, Lake Worth, FL 33467 | No data |
CHANGE OF MAILING ADDRESS | 2024-05-13 | 7408 Lake Worth Rd, Suite 900, Lake Worth, FL 33467 | No data |
CONVERSION | 2024-05-01 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS A97000001254. CONVERSION NUMBER 900000253259 |
Name | Date |
---|---|
Florida Limited Liability | 2024-05-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State