| Entity Name: | OKALOOSA MENTAL HEALTH AND PSYCHIATRIC CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
OKALOOSA MENTAL HEALTH AND PSYCHIATRIC CENTER, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 15 Oct 2003 (22 years ago) |
| Date of dissolution: | 22 Sep 2017 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (8 years ago) |
| Document Number: | P03000113888 |
| FEI/EIN Number |
582678372
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 101 S. JEFFERSON STREET, SUITE C, PENSACOLA, FL, 32502, US |
| Mail Address: | P.O. BOX 12306, PENSACOLA, FL, 32591, US |
| ZIP code: | 32502 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699970962 | 2007-06-18 | 2012-03-05 | 101 S JEFFERSON ST, SUITE C, PENSACOLA, FL, 325025656, US | 101 S JEFFERSON ST, SUITE C, PENSACOLA, FL, 325025656, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 850-432-3334 |
| Fax | 8504323353 |
Authorized person
| Name | DR. KIUMARS SHAMS |
| Role | EXECUTIVE MEDICAL DIRECTOR |
| Phone | 8504323334 |
Taxonomy
| Taxonomy Code | 2084A0401X - Addiction Medicine (Psychiatry & Neurology) Physician |
| License Number | ME29949 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | ME29949 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2084N0402X - Neurology with Special Qualifications in Child Neurology Physician |
| License Number | ME29949 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2084P0005X - Neurodevelopmental Disabilities Physician |
| License Number | ME29949 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ME29949 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 2084P0802X - Addiction Psychiatry Physician |
| License Number | ME29949 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| License Number | ME29949 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2084P0805X - Geriatric Psychiatry Physician |
| License Number | ME29949 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2084P2900X - Pain Medicine (Psychiatry & Neurology) Physician |
| License Number | ME29949 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 208U00000X - Clinical Pharmacology Physician |
| License Number | ME29949 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BC BS FL |
| Number | 79178 |
| State | FL |
| Issuer | MEDICAID |
| Number | 038295700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHAMS KIUMARS E | President | 101 S. JEFFERSON ST., SUITE C, PENSACOLA, FL, 32502 |
| SHAMS KIUMARS E | Secretary | 101 S. JEFFERSON ST., SUITE C, PENSACOLA, FL, 32502 |
| SHAMS KIUMARS E | Treasurer | 101 S. JEFFERSON ST., SUITE C, PENSACOLA, FL, 32502 |
| SHAMS KIUMARS E | Director | 101 S. JEFFERSON ST., SUITE C, PENSACOLA, FL, 32502 |
| SHAMS KIUMARS E | Agent | 101 S. JEFFERSON STREET, PENSACOLA, FL, 32502 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000032956 | ESCAMBIA NEUROPSYCHIATRIC CENTER | EXPIRED | 2011-04-02 | 2016-12-31 | - | P. O. BOX 12306, PENSACOLA, FL, 32591 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | - | - |
| REGISTERED AGENT ADDRESS CHANGED | 2012-01-30 | 101 S. JEFFERSON STREET, SUITE C, PENSACOLA, FL 32502 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2012-01-30 | 101 S. JEFFERSON STREET, SUITE C, PENSACOLA, FL 32502 | - |
| CHANGE OF MAILING ADDRESS | 2012-01-30 | 101 S. JEFFERSON STREET, SUITE C, PENSACOLA, FL 32502 | - |
| REGISTERED AGENT NAME CHANGED | 2012-01-30 | SHAMS, KIUMARS E | - |
| REINSTATEMENT | 2011-01-03 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | - | - |
| CANCEL ADM DISS/REV | 2006-10-11 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-03-27 |
| ANNUAL REPORT | 2015-04-24 |
| ANNUAL REPORT | 2014-03-21 |
| ANNUAL REPORT | 2013-02-27 |
| ANNUAL REPORT | 2012-01-30 |
| REINSTATEMENT | 2011-01-03 |
| ANNUAL REPORT | 2009-04-15 |
| ANNUAL REPORT | 2008-07-10 |
| ANNUAL REPORT | 2007-05-30 |
| REINSTATEMENT | 2006-10-11 |
Date of last update: 03 Apr 2025
Sources: Florida Department of State
