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ADLY THEBAUD, M.D., P.A. - Florida Company Profile

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Company Details

Entity Name: ADLY THEBAUD, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 22 Oct 1991 (34 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 28 Oct 2019 (6 years ago)
Document Number: S88940
FEI/EIN Number 593088555
Address: 2725 REBECCA LN, ORANGE CITY, FL, 32763, US
Mail Address: 2725 REBECCA LN, ORANGE CITY, FL, 32763, US
ZIP code: 32763
City: Orange City
County: Volusia
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
THEBAUD ADLY Agent 2725 REBECCA LN, ORANGE CITY, FL, 32763
THEBAUD, ADLY, M.D. Director 2725 REBECCA LN, ORANGE CITY, FL, 32763
THEBAUD, ADLY, M.D. Manager 2725 REBECCA LN, ORANGE CITY, FL, 32763

National Provider Identifier

NPI Number:
1417018482
Certification Date:
2023-11-09

Authorized Person:

Name:
DR. ADLY THEBAUD
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
2084P0804X - Child & Adolescent Psychiatry Physician
Is Primary:
No
Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
251S00000X - Community/Behavioral Health Agency
Is Primary:
Yes

Contacts:

Fax:
3867750738

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G15000113121 MEDICAL RESEARCH GROUP OF CENTRAL FLORIDA ACTIVE 2015-11-06 2025-12-31 - 2725 REBECCA LANE, STE 107, ORANGE CITY, FL, 32763
G15000109417 AXIS 1 BEHAVIORAL CENTER EXPIRED 2015-10-27 2020-12-31 - 2725 REBECCA LANE, SUITE 103, ORANGE CITY, FL, 32763
G15000109404 FAMILY PSYCHIATRY SERVICES ACTIVE 2015-10-27 2025-12-31 - 1403 MEDICAL PLAZA DRIVE, SUITE 202, SANFORD, FL, 32771
G14000104722 AXIS I BEHAVIORAL CENTER EXPIRED 2014-10-15 2024-12-31 - 2725 REBECCA LANE, SUITE 107, ORANGE CITY, FL, 32763

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2023-12-07 2725 REBECCA LN, #107, ORANGE CITY, FL 32763 -
CHANGE OF PRINCIPAL ADDRESS 2023-11-16 2725 REBECCA LN, SUITE 107, ORANGE CITY, FL 32763 -
CHANGE OF MAILING ADDRESS 2023-11-16 2725 REBECCA LN, SUITE 107, ORANGE CITY, FL 32763 -
REINSTATEMENT 2019-10-28 - -
REGISTERED AGENT NAME CHANGED 2019-10-28 THEBAUD, ADLY -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2019-09-27 - -
REINSTATEMENT 1996-05-02 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 1995-08-25 - -

Documents

Name Date
ANNUAL REPORT 2024-04-11
Reg. Agent Change 2023-12-07
ANNUAL REPORT 2023-04-17
ANNUAL REPORT 2022-03-18
ANNUAL REPORT 2021-02-04
ANNUAL REPORT 2020-05-27
REINSTATEMENT 2019-10-28
ANNUAL REPORT 2018-02-12
ANNUAL REPORT 2017-01-09
ANNUAL REPORT 2016-01-25

USAspending Awards / Financial Assistance

Date:
2020-04-30
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
287500.00
Total Face Value Of Loan:
287500.00

Paycheck Protection Program

Jobs Reported:
24
Initial Approval Amount:
$287,500
Date Approved:
2020-04-30
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$287,500
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$291,588.01
Servicing Lender:
City National Bank of Florida
Use of Proceeds:
Payroll: $215,625
Utilities: $71,875

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Date of last update: 01 Aug 2025

Sources: Florida Department of State