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BLUE RIVER PSYCHIATRY NP PLLC

Company Details

Name: BLUE RIVER PSYCHIATRY NP PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 03 Feb 2022 (3 years ago)
Entity Number: 6395762
ZIP code: 12401
County: Ulster
Place of Formation: New York
Address: 224 FAIR STREET, KINGSTON, NY, United States, 12401

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 224 FAIR STREET, KINGSTON, NY, United States, 12401

National Provider Identifier

NPI Number:
1710633185
Certification Date:
2024-03-14

Authorized Person:

Name:
MINA JOHNSON
Role:
PRACTITIONER
Phone:

Taxonomy:

Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
9144010009

History

Start date End date Type Value
2022-02-04 2022-03-23 Address 224 FAIR STREET, KINGSTON, NY, 12401, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
220323000121 2022-03-22 CERTIFICATE OF PUBLICATION 2022-03-22
220204002425 2022-02-03 ARTICLES OF ORGANIZATION 2022-02-03

Date of last update: 21 Mar 2025

Sources: New York Secretary of State