| Entity Name: | PSYCHIATRY SOLUTIONS CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 14 Aug 2018 (6 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 28 Sep 2020 (4 years ago) |
| Document Number: | P18000069798 |
| FEI/EIN Number | 83-1568299 |
| Address: | 122 SW 52ND TERRACE, CAPE CORAL, FL 33914 |
| Mail Address: | 122 SW 52ND TERRACE, CAPE CORAL, FL 33914 |
| ZIP code: | 33914 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457836884 | 2018-10-02 | 2023-11-30 | 122 SW 52ND TER, CAPE CORAL, FL, 339147129, US | 2500 DEL PRADO BLVD S, CAPE CORAL, FL, 339045750, US | |||||||||||||||||||||||||||||
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| Phone | +1 239-443-8369 |
| Fax | 2394434516 |
| Phone | +1 239-772-1194 |
Authorized person
| Name | DR. JORGE CESAR DIAZ |
| Role | PRESIDENT/OWNER |
| Phone | 2392651791 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | PUHZ6 |
| State | FL |
| Issuer | MEDICAID |
| Number | 025019600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DIAZ, JORGE C | Agent | 122 SW 52ND TERRACE, CAPE CORAL, FL 33914 |
| Name | Role | Address |
|---|---|---|
| DIAZ, JORGE C | Owner | 122 SW 52ND TERRACE, CAPE CORAL, FL 33914 |
| Name | Role | Address |
|---|---|---|
| DIAZ, JORGE C | President | 122 SW 52ND TERRACE, CAPE CORAL, FL 33914 |
| Name | Role | Address |
|---|---|---|
| Diaz, Natasha | Officer | 122 SW 52ND TERRACE, CAPE CORAL, FL 33914 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2020-09-28 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-09-28 | DIAZ, JORGE C | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-04-02 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-02-04 |
| REINSTATEMENT | 2020-09-28 |
| ANNUAL REPORT | 2019-09-26 |
| Domestic Profit | 2018-08-14 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
