| Entity Name: | BRAIN & MIND FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 19 Jul 2024 (6 months ago) |
| Document Number: | L24000318131 |
| Address: | 1505 E MICHIGAN ST, ORLANDO, FL 32806 |
| Mail Address: | 11037 BRIDGE HOUSE RD, WINDERMERE, FL 34786 |
| ZIP code: | 32806 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689497612 | 2024-11-07 | 2024-11-07 | 1505 E MICHIGAN ST, ORLANDO, FL, 328064818, US | 1505 E MICHIGAN ST, ORLANDO, FL, 328064818, US | |||||||||||||||
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| Phone | +1 407-477-5698 |
| Fax | 4072466621 |
Authorized person
| Name | AFTAB QADIR |
| Role | MEDICAL DIRECTOR |
| Phone | 4072466620 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| QADIR, AFTAB | Agent | 1505 E MICHIGAN ST, ORLANDO, FL 32806 |
| Name | Role | Address |
|---|---|---|
| QADIR, AFTAB | Authorized Member | 11037 BRIDGE HOUSE RD, WINDERMERE, FL 34786 |
| QADIR, SOFIA | Authorized Member | 11037 BRIDGE HOUSE RD, WINDERMERE, FL 34786 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-07-19 |
Date of last update: 07 Jan 2025
Sources: Florida Department of State
