| Entity Name: | BLUEWATER BEHAVIORAL HEALTH, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 30 Oct 2018 (6 years ago) |
| Document Number: | P18000090456 |
| FEI/EIN Number | 83-2423740 |
| Address: | 4400 East Highway 20, Suite #306, NICEVILLE, FL 32578 |
| Mail Address: | 4400 East Highway 20, Suite #306, NICEVILLE, FL 32578 |
| ZIP code: | 32578 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922562628 | 2019-01-27 | 2022-10-24 | 4515 PARKVIEW LN, NICEVILLE, FL, 325788734, US | 4400 E HIGHWAY 20 STE 313, NICEVILLE, FL, 325787700, US | |||||||||||||||||
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| Phone | +1 423-930-4667 |
| Phone | +1 575-520-1230 |
| Fax | 7734928765 |
Authorized person
| Name | LEIGH GAYLE POWERS |
| Role | OWNER/PROVIDER |
| Phone | 8507972598 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Powers, Leigh G, Dr. | Agent | 835 Choctaw Ln, Shalimar, FL 32579 |
| Name | Role | Address |
|---|---|---|
| POWERS, LEIGH | Director | 4400 East Highway 20, Suite #306 NICEVILLE, FL 32578 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-01-29 | 4400 East Highway 20, Suite #306, NICEVILLE, FL 32578 | No data |
| CHANGE OF MAILING ADDRESS | 2025-01-29 | 4400 East Highway 20, Suite #306, NICEVILLE, FL 32578 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-29 | 835 Choctaw Ln, Shalimar, FL 32579 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-19 | 4400 East Highway 20, Suite #313, NICEVILLE, FL 32578 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-19 | 4515 Parkview Lane, Niceville, FL 32578 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-19 | 4400 East Highway 20, Suite #313, NICEVILLE, FL 32578 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-01-19 | Powers, Leigh G, Dr. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-29 |
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-02-19 |
| ANNUAL REPORT | 2022-01-29 |
| ANNUAL REPORT | 2021-02-08 |
| ANNUAL REPORT | 2020-01-19 |
| ANNUAL REPORT | 2019-01-29 |
| Domestic Profit | 2018-10-30 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 3931867410 | 2020-05-08 | 0491 | PPP | 4400 E HIGHWAY 20 STE 313, NICEVILLE, FL, 32578-7700 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 16 Feb 2025
Sources: Florida Department of State
