| Entity Name: | PATTERNS BEHAVIORAL SERVICES FLORIDA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 28 Aug 2017 (7 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 01 May 2020 (5 years ago) |
| Document Number: | P17000072364 |
| FEI/EIN Number | 36-4877362 |
| Address: | 12760 W. 8th St. Pkwy, Lenexa, IA 66215 |
| Mail Address: | 12760 W. 8th St. Pkwy, Lenexa, IA 66215 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740777556 | 2018-04-17 | 2018-06-16 | 3230 E IMPERIAL HWY STE 203, BREA, CA, 928211706, US | 12000 N DALE MABRY HWY STE 112, TAMPA, FL, 336183311, US | |||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 657-444-9002 |
| Fax | 7146771785 |
| Phone | +1 813-333-5024 |
Authorized person
| Name | IHAB F SHAHAWI |
| Role | CEO |
| Phone | 6572069594 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
| Taxonomy Code | 106E00000X - Assistant Behavior Analyst |
| Is Primary | No |
| Taxonomy Code | 106S00000X - Behavior Technician |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 320900000X - Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022087100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION | Agent | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 |
| Name | Role | Address |
|---|---|---|
| Shahawi, Ihab | Chief Executive Officer | 12760 W. 8th St. Pkwy, Lenexa, IA 66215 |
| Name | Role | Address |
|---|---|---|
| Shahawi, Ihab | Director | 12760 W. 8th St. Pkwy, Lenexa, IA 66215 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-11 | 12760 W. 8th St. Pkwy, Lenexa, IA 66215 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-11 | 12760 W. 8th St. Pkwy, Lenexa, IA 66215 | No data |
| REINSTATEMENT | 2020-05-01 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-05-01 | CT CORPORATION | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-11 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-03-28 |
| ANNUAL REPORT | 2021-04-22 |
| REINSTATEMENT | 2020-05-01 |
| ANNUAL REPORT | 2018-04-13 |
| Domestic Profit | 2017-08-28 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
