| Entity Name: | PROFESSIONAL PSYCHIATRIC ASSOCIATES INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 27 Oct 2010 (14 years ago) |
| Document Number: | P10000088376 |
| FEI/EIN Number | 80-0654723 |
| Address: | 6150 Metrowest blvd, Suite 101, Orlando, FL 32835 |
| Mail Address: | 6150 Metrowest blvd, 101, Orlando, FL 32835 |
| ZIP code: | 32835 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659795466 | 2014-02-13 | 2014-02-13 | 2545 PARTRIDGE DR, WINTER HAVEN, FL, 338843033, US | 2545 PARTRIDGE DR, WINTER HAVEN, FL, 338843033, US | |||||||||||||||||||||||||||||||
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| Phone | +1 863-206-0015 |
Authorized person
| Name | IFTIKHAR RASUL |
| Role | PRESIDENT |
| Phone | 8632060015 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ME88613 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | ME88613 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 43193Z |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RASUL, IFTIKHAR | Agent | 6150 Metrowest blvd, 101, Orlando, FL 32835 |
| Name | Role | Address |
|---|---|---|
| RASUL, IFTIKHAR | President | 6150 Metrowest Blvd, Orlando, FL 32835 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-16 | 6150 Metrowest blvd, Suite 101, Orlando, FL 32835 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-16 | 6150 Metrowest blvd, Suite 101, Orlando, FL 32835 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-16 | 6150 Metrowest blvd, 101, Orlando, FL 32835 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-11 |
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-05-01 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-01-22 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-16 |
| ANNUAL REPORT | 2017-01-19 |
| ANNUAL REPORT | 2016-03-08 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 5391047310 | 2020-04-30 | 0491 | PPP | 6150 Metrowest Blvd,, orlando, FL, 32835 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 23 Feb 2025
Sources: Florida Department of State
