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MINDFUL CARE NP IN PSYCHIATRY AND NP IN ADULT HEALTH P.C.

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Company Details

Name: MINDFUL CARE NP IN PSYCHIATRY AND NP IN ADULT HEALTH P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 13 Oct 2023 (2 years ago)
Entity Number: 7157594
ZIP code: 11226
County: Kings
Place of Formation: New York
Address: 571 east 19th street, apt. 6b, BROOKLYN, NY, United States, 11226

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
the corporation DOS Process Agent 571 east 19th street, apt. 6b, BROOKLYN, NY, United States, 11226

National Provider Identifier

NPI Number:
1174380141
Certification Date:
2025-05-12

Authorized Person:

Name:
ERICKA DEADWYLER-GOURGUE
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363LA2200X - Adult Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
9292745330

History

Start date End date Type Value
2023-10-13 2024-04-23 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0

Filings

Filing Number Date Filed Type Effective Date
231013001924 2023-10-13 CERTIFICATE OF INCORPORATION 2023-10-13

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Date of last update: 20 Mar 2025

Sources: New York Secretary of State