| Entity Name: | LINZEY FAISON MENTAL HEALTH ASSOCIATES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 20 Dec 2004 (20 years ago) |
| Date of dissolution: | 24 Sep 2010 (14 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2010 (14 years ago) |
| Document Number: | P04000170148 |
| FEI/EIN Number | 202028827 |
| Address: | 501 BOLIVAR STREET, CHATTAHOOCHEE, FL, 32324 |
| Mail Address: | P.O. BOX 486, CHATTAHOOCHEE, FL, 32324 |
| ZIP code: | 32324 |
| County: | Gadsden |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285679340 | 2006-06-20 | 2008-12-22 | PO BOX 486, CHATTAHOOCHEE, FL, 323240486, US | 501 S BOLIVAR ST, CHATTAHOOCHEE, FL, 323241347, US | |||||||||||||||||||||||||
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| Phone | +1 850-663-4347 |
| Fax | 8506634727 |
Authorized person
| Name | MR. LINZEY R. FAISON |
| Role | PRESIDENT |
| Phone | 8506634347 |
Taxonomy
| Taxonomy Code | 364SP0808X - Psychiatric/Mental Health Clinical Nurse Specialist |
| License Number | FL637562 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 301562900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FAISON LINZEY R | Agent | 329 GOULD ROAD, QUINCY, FL, 32351 |
| Name | Role | Address |
|---|---|---|
| FAISON LINZEY R | President | 501 BOLIVAR STREET, CHATTAHOOCHEE, FL, 32324 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-01-07 | 501 BOLIVAR STREET, CHATTAHOOCHEE, FL 32324 | No data |
| NAME CHANGE AMENDMENT | 2005-06-15 | LINZEY FAISON MENTAL HEALTH ASSOCIATES, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2009-03-24 |
| ANNUAL REPORT | 2008-01-07 |
| ANNUAL REPORT | 2007-01-09 |
| ANNUAL REPORT | 2006-02-27 |
| Name Change | 2005-06-15 |
| Domestic Profit | 2004-12-20 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
