| Entity Name: | ATLANTIC MENTAL HEALTH PROGRAM, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Feb 1996 (29 years ago) |
| Document Number: | P96000010526 |
| FEI/EIN Number | 650645919 |
| Address: | 654 NE 9TH PLACE, HOMESTEAD, FL, 33030 |
| Mail Address: | 654 NE 9TH PLACE, HOMESTEAD, FL, 33030 |
| ZIP code: | 33030 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770511479 | 2006-06-29 | 2018-06-07 | 654 NE 9TH PL, HOMESTEAD, FL, 330304934, US | 654 NE 9TH PL, HOMESTEAD, FL, 33030, US | |||||||||||||||||||||||||||||
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| Phone | +1 305-248-3488 |
| Fax | 3052483488 |
Authorized person
| Name | MRS. AIDELYN LOPEZ |
| Role | PRESIDENT ADMINISTRATOR |
| Phone | 3052483488 |
Taxonomy
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | HCC4181 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004814500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LOPEZ AIDELYN | Agent | 654 NE 9TH PLACE, HOMESTEAD, FL, 33030 |
| Name | Role | Address |
|---|---|---|
| LOPEZ AIDELYN | Vice President | 654 NE 9TH PLACE, HOMESTEAD, FL, 33030 |
| Name | Role |
|---|---|
| HOMESTEAD HEALTH CLINIC LLC | President |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000125487 | HOMESTEAD BEHAVIORAL CLINIC "HBC" | ACTIVE | 2024-10-09 | 2029-12-31 | No data | 654 NE 9TH PLACE, HOMESTEAD, FL, 33030 |
| G23000064639 | HOMESTEAD BEHAVIORAL CLINIC, "HBC" | ACTIVE | 2023-05-24 | 2028-12-31 | No data | 654 NE 9TH PLACE, HOMESTEAD, FL, 33030 |
| G16000025912 | HOMESTEAD BEHAVIORAL CLINIC, "HBC" | EXPIRED | 2016-03-10 | 2021-12-31 | No data | 654 NE 9TH PLACE, HOMESTEAD, FL, 33030 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2007-01-05 | 654 NE 9TH PLACE, HOMESTEAD, FL 33030 | No data |
| CHANGE OF MAILING ADDRESS | 2007-01-05 | 654 NE 9TH PLACE, HOMESTEAD, FL 33030 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-01-05 | 654 NE 9TH PLACE, HOMESTEAD, FL 33030 | No data |
| REGISTERED AGENT NAME CHANGED | 2001-02-07 | LOPEZ, AIDELYN | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J13000000738 | LAPSED | 2010-020883 FC 17 | ELEVENTH JUDICIAL CIRCUIT | 2012-12-27 | 2018-01-02 | $4,248/24 | ADA G. LLERENA, ESQ., 10631 N. KENDALL DRIVE, SUITE 205, MIAMI, FL 33176 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-12 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-25 |
| ANNUAL REPORT | 2021-01-12 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-01-08 |
| ANNUAL REPORT | 2017-01-04 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-03-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
