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EVERNORTH BEHAVIORAL CARE GROUP OF FLORIDA, P.A. - Florida Company Profile

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Company Details

Entity Name: EVERNORTH BEHAVIORAL CARE GROUP OF FLORIDA, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 21 Jul 2022 (3 years ago)
Last Event: NAME CHANGE AMENDMENT
Event Date Filed: 02 May 2023 (2 years ago)
Document Number: P22000058520
FEI/EIN Number 88-3761074
Address: 255 TECHNOLOGY PARK, LAKE MARY, FL, 32746, US
Mail Address: 6625 WEST 78TH STREET, BLOOMINGTON, MN, 55439, US
ZIP code: 32746
City: Lake Mary
County: Seminole
Place of Formation: FLORIDA

Links between entities

Type:
Headquarter of
Company Number:
20251144513
State:
COLORADO
Type:
Headquarter of
Company Number:
6115419
State:
IDAHO
Type:
Headquarter of
Company Number:
1477598
State:
MISSISSIPPI
Type:
Headquarter of
Company Number:
001-195-224
State:
ALABAMA
Type:
Headquarter of
Company Number:
2781735
State:
CONNECTICUT
Type:
Headquarter of
Company Number:
CORP_74795803
State:
ILLINOIS
Type:
Headquarter of
Company Number:
602ffefc-10b4-ef11-908b-00155d32b947
State:
MINNESOTA
Type:
Headquarter of
Company Number:
undefined605236963
State:
WASHINGTON

Key Officers & Management

Name Role Address
Torres Luis EMD Vice President 255 TECHNOLOGY PARK, LAKE MARY, FL, 32746
Torres Luis MMD Asst 255 TECHNOLOGY PARK, LAKE MARY, FL, 32746
LOPEZ WILLIAM MMD President 255 TECHNOLOGY PARK, LAKE MARY, FL, 32746
LOPEZ WILLIAM MMD Secretary 255 TECHNOLOGY PARK, LAKE MARY, FL, 32746
LOPEZ WILLIAM MMD Treasurer 255 TECHNOLOGY PARK, LAKE MARY, FL, 32746
LOPEZ WILLIAM MMD Director 255 TECHNOLOGY PARK, LAKE MARY, FL, 32746
- Agent -

National Provider Identifier

NPI Number:
1053030643
Certification Date:
2023-12-07

Authorized Person:

Name:
ELIZABETH NELSON
Role:
LEGAL COUNSEL
Phone:

Taxonomy:

Selected Taxonomy:
103T00000X - Psychologist
Is Primary:
No
Selected Taxonomy:
101Y00000X - Counselor
Is Primary:
Yes

Contacts:

Events

Event Type Filed Date Value Description
NAME CHANGE AMENDMENT 2023-05-02 EVERNORTH BEHAVIORAL CARE GROUP OF FLORIDA, P.A. -

Documents

Name Date
ANNUAL REPORT 2024-04-30
Name Change 2023-05-02
ANNUAL REPORT 2023-02-27
Domestic Profit 2022-07-21

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Date of last update: 01 Jul 2025

Sources: Florida Department of State