| Entity Name: | YANTRA PSYCHIATRIC SERVICES INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Apr 2016 (9 years ago) |
| Document Number: | P16000037208 |
| FEI/EIN Number | 81-2372215 |
| Address: | 6700 S Florida Ave, LAKELAND, FL, 33813, US |
| Mail Address: | 6700 S Florida Ave, LAKELAND, FL, 33813, US |
| ZIP code: | 33813 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528588878 | 2017-06-27 | 2022-04-25 | 6700 S FLORIDA AVE STE 33, LAKELAND, FL, 338133312, US | 6700 S FLORIDA AVE STE 33, LAKELAND, FL, 338133312, US | |||||||||||||||||||||||||||||||
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| Phone | +1 863-450-3067 |
| Fax | 8633374123 |
Authorized person
| Name | DR. ROSA E NEGRON-MUNOZ |
| Role | MEDICAL DIRECTOR |
| Phone | 8634503067 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ME111271 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003962200 |
| State | FL |
| Issuer | MEDICAID |
| Number | 022279400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NEGRON-MUNOZ ROSA EMD | Agent | 6700 S Florida Ave, Lakeland, FL, 33813 |
| Name | Role | Address |
|---|---|---|
| NEGRON-MUNOZ ROSA EMD | President | 6700 S Florida Ave, LAKELAND, FL, 33813 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-23 | 6700 S Florida Ave, STE 33, Lakeland, FL 33813 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-05-16 | 6700 S Florida Ave, STE 33, LAKELAND, FL 33813 | No data |
| CHANGE OF MAILING ADDRESS | 2022-05-16 | 6700 S Florida Ave, STE 33, LAKELAND, FL 33813 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-01 |
| ANNUAL REPORT | 2023-02-23 |
| ANNUAL REPORT | 2022-03-04 |
| ANNUAL REPORT | 2021-03-14 |
| ANNUAL REPORT | 2020-06-01 |
| ANNUAL REPORT | 2019-02-13 |
| ANNUAL REPORT | 2018-01-29 |
| ANNUAL REPORT | 2017-02-19 |
| Domestic Profit | 2016-04-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
