| Entity Name: | PALMETTO BEHAVIORAL MEDICINE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 09 Apr 2008 (17 years ago) |
| Document Number: | P08000036671 |
| FEI/EIN Number | 262374243 |
| Address: | 3002 SE 1ST AVE BLDG 100, OCALA, FL, 34471 |
| Mail Address: | 3002 SE 1ST AVE BLDG 100, OCALA, FL, 34471 |
| ZIP code: | 34471 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619140662 | 2008-04-10 | 2014-10-01 | 3002 SE 1ST AVE, SUITE 100, OCALA, FL, 344710407, US | 3002 SE 1ST AVE, SUITE 100, OCALA, FL, 344710407, US | |||||||||||||||||||||||||
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| Phone | +1 352-368-2448 |
Authorized person
| Name | DR. MICAH DENNIS BAXLEY |
| Role | PRESIDENT |
| Phone | 3523682448 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ME100494 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 2084P0805X - Geriatric Psychiatry Physician |
| License Number | ME100494 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| BAXLEY MICAH D | Agent | 3002 SE 1ST AVE BLDG 100, OCALA, FL, 34471 |
| Name | Role | Address |
|---|---|---|
| BAXLEY MICAH D | President | 3002 SE 1ST AVE BLDG 100, OCALA, FL, 34471 |
| Name | Role | Address |
|---|---|---|
| BAXLEY MICAH D | Secretary | 3002 SE 1ST AVE BLDG 100, OCALA, FL, 34471 |
| Name | Role | Address |
|---|---|---|
| BAXLEY MICAH D | Treasurer | 3002 SE 1ST AVE BLDG 100, OCALA, FL, 34471 |
| Name | Role | Address |
|---|---|---|
| BAXLEY MICAH D | Director | 3002 SE 1ST AVE BLDG 100, OCALA, FL, 34471 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2011-03-17 | 3002 SE 1ST AVE BLDG 100, OCALA, FL 34471 | No data |
| CHANGE OF MAILING ADDRESS | 2011-03-17 | 3002 SE 1ST AVE BLDG 100, OCALA, FL 34471 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-03-17 | 3002 SE 1ST AVE BLDG 100, OCALA, FL 34471 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-31 |
| ANNUAL REPORT | 2023-04-08 |
| ANNUAL REPORT | 2022-03-25 |
| ANNUAL REPORT | 2021-04-18 |
| ANNUAL REPORT | 2020-04-25 |
| ANNUAL REPORT | 2019-04-06 |
| ANNUAL REPORT | 2018-04-07 |
| ANNUAL REPORT | 2017-04-16 |
| ANNUAL REPORT | 2016-04-15 |
| ANNUAL REPORT | 2015-04-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
