| Entity Name: | ONE STOP COMMUNITY BASE BEHAVIORAL HEALTHCARE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 Apr 2017 (8 years ago) |
| Document Number: | P17000036497 |
| FEI/EIN Number | 82-1300982 |
| Address: | 3025 FARRINGTON STREET, JACKSONVILLE, FL, 32224 |
| Mail Address: | 3025 FARRINGTON STREET, JACKSONVILLE, FL, 32224 |
| ZIP code: | 32224 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700360039 | 2018-09-21 | 2018-09-21 | 3025 FARRINGTON ST, JACKSONVILLE, FL, 322241821, US | 12058 SAN JOSE BLVD STE 903, JACKSONVILLE, FL, 322238667, US | |||||||||||||||||||||||
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| Phone | +1 904-403-3241 |
| Fax | 9042235396 |
| Fax | 9048860382 |
Authorized person
| Name | MRS. FARKHANDA KHAN |
| Role | THERAPIST |
| Phone | 9044033241 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1528489598 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KHAWAJA REHAN NESQUIRE | Agent | 817 NORTH MAIN STREET, JACKSONVILLE, FL, 32202 |
| Name | Role | Address |
|---|---|---|
| KHAN FARKHANDA | President | 3025 FARRINGTON STREET, JACKSONVILLE, FL, 32224 |
| Name | Role | Address |
|---|---|---|
| AWAN ZAFAR | Vice President | 3025 FARRINGTON STREET, JACKSONVILLE, FL, 32224 |
| Name | Role | Address |
|---|---|---|
| AWAN ZAFAR | Secretary | 3025 FARRINGTON STREET, JACKSONVILLE, FL, 32224 |
| Name | Role | Address |
|---|---|---|
| AWAN ZAFAR | Treasurer | 3025 FARRINGTON STREET, JACKSONVILLE, FL, 32224 |
| Name | Role | Address |
|---|---|---|
| KHAN FARKHANDA | Director | 3025 FARRINGTON STREET, JACKSONVILLE, FL, 32224 |
| AWAN ZAFAR | Director | 3025 FARRINGTON STREET, JACKSONVILLE, FL, 32224 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-03 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-03-12 |
| ANNUAL REPORT | 2021-02-13 |
| ANNUAL REPORT | 2020-03-28 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-03-24 |
| Domestic Profit | 2017-04-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
