| Entity Name: | VOLUSIA PSYCHIATRY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 06 Jul 2001 (24 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | P01000066657 |
| FEI/EIN Number | 593732080 |
| Address: | 1106 BEL AIRE DR., DAYTONA BEACH, FL, 32118 |
| Mail Address: | 1106 BEL AIRE DR., DAYTONA BEACH, FL, 32118 |
| ZIP code: | 32118 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295053585 | 2010-05-11 | 2011-07-11 | 450 W STATE ROAD 434, LONGWOOD, FL, 327505187, US | 450 W STATE ROAD 434, LONGWOOD, FL, 327505187, US | |||||||||||||||||||||||
|
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| Phone | +1 386-299-3393 |
Authorized person
| Name | BASSAM A AMAWI |
| Role | OWNER |
| Phone | 3862993393 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ME50613 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 2592282 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SCOTT ROBERT H | Agent | 341 PARQUE DR #7, ORMOND BEACH, FL, 32174 |
| Name | Role | Address |
|---|---|---|
| AMAWI BASSAM A | Director | 1106 BEL AIRE DR., DAYTONA BEACH, FL, 32118 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-02-02 | 341 PARQUE DR #7, ORMOND BEACH, FL 32174 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-05-11 |
| ANNUAL REPORT | 2012-02-02 |
| ANNUAL REPORT | 2011-02-17 |
| ANNUAL REPORT | 2010-03-21 |
| ANNUAL REPORT | 2009-03-14 |
| ANNUAL REPORT | 2008-01-30 |
| ANNUAL REPORT | 2007-02-24 |
| ANNUAL REPORT | 2006-04-26 |
| ANNUAL REPORT | 2005-04-06 |
| ANNUAL REPORT | 2004-03-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
