| Entity Name: | BAY PSYCHIATRIC SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 01 Apr 1996 (29 years ago) |
| Date of dissolution: | 25 Sep 2009 (15 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2009 (15 years ago) |
| Document Number: | P96000029851 |
| FEI/EIN Number | 59-3359724 |
| Address: | 3227 COUNTRY CLUB DR., LYNN HAVEN, FL 32444 |
| Mail Address: | 3227 COUNTRY CLUB DR., LYNN HAVEN, FL 32444 |
| ZIP code: | 32444 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437182219 | 2006-07-07 | 2020-08-22 | 3227 COUNTRY CLUB DR, LYNN HAVEN, FL, 324445125, US | 3227 COUNTRY CLUB DR, LYNN HAVEN, FL, 324445125, US | |||||||||||||||||||||||||
|
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| Phone | +1 850-271-9674 |
| Fax | 8502489020 |
Authorized person
| Name | DR. GEORGE B JERUSALEM |
| Role | PRESIDENT |
| Phone | 8502719674 |
Taxonomy
| Taxonomy Code | 2084P0805X - Geriatric Psychiatry Physician |
| License Number | ME27468 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD FL |
| Number | 14310 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JERUSALEM, GEORGE B | Agent | 3227 COUNTRY CLUB DR., LYNN HAVEN, FL 32444 |
| Name | Role | Address |
|---|---|---|
| JERUSALEM, GEORGE B | Director | 3227 COUNTRY CLUB DR., LYNN HAVEN, FL 32444 |
| JERUSALEM, TESSIE M | Director | 3227 COUNTRY CLUB DR., LYNN HAVEN, FL 32444 |
| JERUSALEM, JASON | Director | 3227 COUNTRY CLUB DR., LYNN HAVEN, FL 32444 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2008-04-24 |
| ANNUAL REPORT | 2007-02-26 |
| ANNUAL REPORT | 2006-02-03 |
| ANNUAL REPORT | 2005-04-19 |
| ANNUAL REPORT | 2004-04-27 |
| ANNUAL REPORT | 2003-04-11 |
| ANNUAL REPORT | 2002-08-28 |
| ANNUAL REPORT | 2001-02-28 |
| ANNUAL REPORT | 2000-01-22 |
| ANNUAL REPORT | 1999-02-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
