| Entity Name: | PEDIATRIC BEHAVIORAL HEALTH ASSOCIATES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Mar 2018 (7 years ago) |
| Document Number: | P18000022863 |
| FEI/EIN Number | 83-4141335 |
| Address: | 5818 SE AGNEW RD, BELLEVIEW, FL, 34420, US |
| Mail Address: | 5818 SE AGNEW RD, BELLEVIEW, FL, 34420, US |
| ZIP code: | 34420 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174385470 | 2024-01-23 | 2024-03-20 | 2735 SE 140TH PL, SUMMERFIELD, FL, 344912877, US | 5818 SE AGNEW RD, BELLEVIEW, FL, 344204020, US | |||||||||||||
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| Phone | +1 561-715-5910 |
Authorized person
| Name | DR. NICOLE WOLLER |
| Role | PRESIDENT |
| Phone | 5617061004 |
Taxonomy
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WOLLER NIKKI | Agent | 5818 SE AGNEW RD, BELLEVIEW, FL, 34420 |
| Name | Role | Address |
|---|---|---|
| WOLLER NICOLE | President | 5818 SE AGNEW RD, BELLEVIEW, FL, 34420 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000039279 | PEDIATRIC BEHAVIORAL HEALTH INSTITUTE OF MARION COUNTY | EXPIRED | 2019-03-26 | 2024-12-31 | No data | 2735 SE 140 PL, SUMMERFIELD, FL, 34491 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-28 | 5818 SE AGNEW RD, BELLEVIEW, FL 34420 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-28 | 5818 SE AGNEW RD, BELLEVIEW, FL 34420 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-28 | 5818 SE AGNEW RD, BELLEVIEW, FL 34420 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-04-16 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-06-28 |
| ANNUAL REPORT | 2019-04-30 |
| Domestic Profit | 2018-03-08 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
