| Entity Name: | REVITALIZE PSYCHIATRIC SERVICES II, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 16 Oct 2023 (a year ago) |
| Date of dissolution: | 15 Aug 2024 (6 months ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 15 Aug 2024 (6 months ago) |
| Document Number: | P23000073478 |
| Address: | 27524 CASHFORD CIRCLE, 102, WESLEY CHAPEL, FL 33544 UN |
| Mail Address: | 11919 CASTINE ST, NEW PORT RICHEY, FL 34654 UN |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134995426 | 2023-11-28 | 2023-11-28 | 11919 CASTINE ST, NEW PORT RICHEY, FL, 346541807, US | 27524 CASHFORD CIR STE 102, WESLEY CHAPEL, FL, 335446947, US | |||||||||||||||||||||||
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| Phone | +1 815-212-1478 |
| Fax | 8139067789 |
Authorized person
| Name | KELLY LYNN HUFFMAN |
| Role | CEO |
| Phone | 8152121478 |
Taxonomy
| Taxonomy Code | 363LG0600X - Gerontology Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| HUFFMAN, KELLY L, DNP | Agent | 11919 CASTINE ST, NEW PORT RICHEY, FL 34654 |
| Name | Role | Address |
|---|---|---|
| HUFFMAN, KELLY L, DNP | President | 7900 EAST UNION AVE., SUITE 1100, DENVER, CO 80237 UN |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2024-08-15 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2024-08-15 |
| Domestic Profit | 2023-10-16 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
