| Entity Name: | PHOENIX BEHAVIORAL HEALTH SERVICES INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Active |
| Date Filed: | 29 Mar 2024 (a year ago) |
| Document Number: | N24000004032 |
| Address: | 9109 BAYMEADOWS RD STE 3, JACKSONVILLE, FL 32256 |
| Mail Address: | 9109 BAYMEADOWS RD STE 3, JACKSONVILLE, FL 32256 |
| ZIP code: | 32256 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972330272 | 2024-09-19 | 2024-09-19 | 9109 BAYMEADOWS RD STE 3, JACKSONVILLE, FL, 322561842, US | 9109 BAYMEADOWS RD STE 3, JACKSONVILLE, FL, 322561842, US | |||||||||||||||||||||||||
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| Phone | +1 904-227-2280 |
Authorized person
| Name | CHERMERA YVONNE SMITH |
| Role | DIRECTOR |
| Phone | 9042272280 |
Taxonomy
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QR0405X - Substance Use Disorder Rehabilitation Clinic/Center |
| Is Primary | No |
| Name | Role |
|---|---|
| UNITED STATES CORPORATION AGENTS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| SMITH, CHERMERA | Director | 9109 BAYMEADOWS RD STE 3, JACKSONVILLE, FL 32256 |
| JOHNSTON, ADRIENNE | Director | 9109 BAYMEADOWS RD STE 3, JACKSONVILLE, FL 32256 |
| WILLIAMS, KRISTEN S | Director | 9109 BAYMEADOWS RD STE 3, JACKSONVILLE, FL 32256 |
| Name | Date |
|---|---|
| Domestic Non-Profit | 2024-03-29 |
Date of last update: 08 Feb 2025
Sources: Florida Department of State
