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  5. FIRST COAST MENTAL HEALTH P.A.

FIRST COAST MENTAL HEALTH P.A.

Company Details

Entity Name: FIRST COAST MENTAL HEALTH P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 26 Mar 2008 (17 years ago)
Document Number: P08000031811
FEI/EIN Number 223977578
Address: 1409 KINGSLEY AVE., SUITE 8, ORANGE PARK, FL, 32073, US
Mail Address: 1409 KINGSLEY AVE., SUITE 8, ORANGE PARK, FL, 32073, US
ZIP code: 32073
County: Clay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1285884650 2008-09-23 2022-10-19 1409 KINGSLEY AVE STE 8, ORANGE PARK, FL, 320734553, US 1409 KINGSLEY AVE STE 8, ORANGE PARK, FL, 320734553, US

Contacts
Phone +1 904-269-7200
Fax 9042690070

Authorized person
Name MELODY D TAYLOR
Role OFFICE MANAGER
Phone 9042697200

Taxonomy
Taxonomy Code 2084P0800X - Psychiatry Physician
License Number ME100502
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FIRST COAST MENTAL HEALTH P A 401(K) PROFIT SHARING PLAN & TRUST 2023 223977578 2024-07-30 FIRST COAST MENTAL HEALTH P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9044343899
Plan sponsor’s address 1409 KINGSLEY AVE STE 8, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2024-07-30
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401(K) PROFIT SHARING PLAN & TRUST 2022 223977578 2023-07-26 FIRST COAST MENTAL HEALTH P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2023-07-26
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401(K) PROFIT SHARING PLAN & TRUST 2021 223977578 2022-07-19 FIRST COAST MENTAL HEALTH P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2022-07-19
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401(K) PROFIT SHARING PLAN & TRUST 2020 223977578 2021-07-21 FIRST COAST MENTAL HEALTH P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2021-07-21
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401(K) PROFIT SHARING PLAN & TRUST 2019 223977578 2020-07-20 FIRST COAST MENTAL HEALTH P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2020-07-20
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401 K PROFIT SHARING PLAN TRUST 2018 223977578 2019-07-31 FIRST COAST MENTAL HEALTH P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2019-07-31
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401 K PROFIT SHARING PLAN TRUST 2017 223977578 2018-07-10 FIRST COAST MENTAL HEALTH P A 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9042697208
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2018-07-10
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401 K PROFIT SHARING PLAN TRUST 2016 223977578 2017-07-28 FIRST COAST MENTAL HEALTH P A 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2017-07-28
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401 K PROFIT SHARING PLAN TRUST 2015 223977578 2016-07-27 FIRST COAST MENTAL HEALTH P A 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2016-07-27
Name of individual signing KATHLEEN GRISSETT
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401 K PROFIT SHARING PLAN TRUST 2014 223977578 2015-07-22 FIRST COAST MENTAL HEALTH P A 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2015-07-22
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
WILLIAM G HAEBERLE Agent 1440 PEACHTREE ST, JAX, FL, 32207

President

Name Role Address
GRISSETT KATHLEEN B President 1543 kingsley ave, ORANGE PARK, FL, 32073

Vice President

Name Role Address
GRISSETT KATHLEEN B Vice President 1543 kingsley ave, ORANGE PARK, FL, 32073

Secretary

Name Role Address
GRISSETT KATHLEEN B Secretary 1543 kingsley ave, ORANGE PARK, FL, 32073

Treasurer

Name Role Address
GRISSETT KATHLEEN B Treasurer 1543 kingsley ave, ORANGE PARK, FL, 32073

Director

Name Role Address
GRISSETT KATHLEEN B Director 1543 Kingsley ave, ORANGE PARK, FL, 32073

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2023-04-20 1409 KINGSLEY AVE., SUITE 8, ORANGE PARK, FL 32073 No data
CHANGE OF MAILING ADDRESS 2023-04-20 1409 KINGSLEY AVE., SUITE 8, ORANGE PARK, FL 32073 No data
REGISTERED AGENT NAME CHANGED 2012-04-23 WILLIAM G HAEBERLE No data
REGISTERED AGENT ADDRESS CHANGED 2012-04-23 1440 PEACHTREE ST, JAX, FL 32207 No data

Documents

Name Date
ANNUAL REPORT 2024-04-29
ANNUAL REPORT 2023-04-20
ANNUAL REPORT 2022-04-26
ANNUAL REPORT 2021-04-07
ANNUAL REPORT 2020-04-29
ANNUAL REPORT 2019-04-24
ANNUAL REPORT 2018-04-26
ANNUAL REPORT 2017-04-18
ANNUAL REPORT 2016-04-12
ANNUAL REPORT 2015-04-29

Related by officers

GRISSETT KATHLEEN B

CHARMICHAEL ENTERPRISE LLC MICHARLIE HOLDINGS, LLC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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