| Entity Name: | PEACE OF MIND BEHAVIORAL HEALTH INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 06 Dec 2018 (6 years ago) |
| Document Number: | P18000099331 |
| FEI/EIN Number | 83-2549042 |
| Address: | 12094 Anderson Rd Suite 177, TAMPA, FL 33625 |
| Mail Address: | 12094 Anderson Rd Suite 177, TAMPA, FL 33625 |
| ZIP code: | 33625 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497224778 | 2018-11-16 | 2024-09-10 | 12094 ANDERSON RD # 177, TAMPA, FL, 336255682, US | 12094 ANDERSON RD # 177, TAMPA, FL, 336255682, US | |||||||||||||||||||||
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| Phone | +1 813-316-6500 |
| Fax | 8134342353 |
Authorized person
| Name | JESSICA RONDON |
| Role | CEO AND FOUNDER |
| Phone | 8137851551 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008867000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RONDON, JESSICA | Agent | 12094 Anderson Rd Suite 177, TAMPA, FL 33625 |
| Name | Role | Address |
|---|---|---|
| RONDON, JESSICA | President | 12094 Anderson Rd Suite 177, TAMPA, FL 33625 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-10 | 12094 Anderson Rd Suite 177, TAMPA, FL 33625 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-10 | 12094 Anderson Rd Suite 177, TAMPA, FL 33625 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-10 | 12094 Anderson Rd Suite 177, TAMPA, FL 33625 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-01-14 | RONDON, JESSICA | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-04-26 |
| ANNUAL REPORT | 2022-04-10 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-01-14 |
| ANNUAL REPORT | 2019-03-22 |
| Domestic Profit | 2018-12-06 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
