| Entity Name: | ADVANCED PSYCHIATRIC SERVICES PROFESSIONAL ASSOCIATION, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 29 Mar 2022 (3 years ago) |
| Document Number: | P22000027507 |
| FEI/EIN Number | 88-1909786 |
| Address: | 7369 SHERIDAN STREET, SUITE 203, HOLLYWOOD, FL, 33024 |
| Mail Address: | 7369 SHERIDAN STREET, SUITE 203, HOLLYWOOD, FL, 33024 |
| ZIP code: | 33024 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710603550 | 2022-10-13 | 2024-10-04 | 7369 SHERIDAN ST STE 203, HOLLYWOOD, FL, 330242776, US | 7369 SHERIDAN ST STE 203, HOLLYWOOD, FL, 330242776, US | |||||||||||||||||||||||||||||||
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| Phone | +1 954-369-4111 |
| Fax | 9543500909 |
Authorized person
| Name | ALEXANDER PUSHKA |
| Role | OWNER |
| Phone | 9545791110 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0805X - Geriatric Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 364SP0808X - Psychiatric/Mental Health Clinical Nurse Specialist |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| KLEYMAN ROMAN | Agent | 7369 SHERIDAN STREET, HOLLYWOOD, FL, 33024 |
| Name | Role | Address |
|---|---|---|
| PUSHKA ALEXANDER MD | President | 7369 SHERIDAN STREET, HOLLYWOOD, FL, 33024 |
| Name | Role | Address |
|---|---|---|
| KAPLAN MILANA MD | Vice President | 7369 SHERIDAN STREET, HOLLYWOOD, FL, 33024 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-29 |
| Domestic Profit | 2022-03-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
