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AFFECT PROVIDER GROUP, P.S.C.

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Company Details

Name: AFFECT PROVIDER GROUP, P.S.C.
Legal type: Kentucky Professional Services Corp
Status: Active
Standing: Good
Profit or Non-Profit: Profit
File Date: 14 Dec 2021 (3 years ago)
Organization Date: 14 Dec 2021 (3 years ago)
Last Annual Report: 27 Jun 2024 (a year ago)
Organization Number: 1181463
Industry: Health Services
Number of Employees: Small (0-19)
ZIP code: 40422
City: Danville
Primary County: Boyle County
Principal Office: 116 North Third Street, Suite 3, Danville, KY 40422
Place of Formation: KENTUCKY
Authorized Shares: 1000

President

Name Role
Doug Elwood, M.D. President

Treasurer

Name Role
Andrea Lapus Treasurer

Shareholder

Name Role
Doug Elwood, M.D. Shareholder

Registered Agent

Name Role
CORPORATION SERVICE COMPANY Registered Agent

Incorporator

Name Role
ANASTASIA JANDES M.D. Incorporator

Links between entities

Type:
Headquarter of
Company Number:
7260011
State:
NEW YORK
Type:
Headquarter of
Company Number:
001766936
State:
RHODE ISLAND
Type:
Headquarter of
Company Number:
04fd7165-1bde-ed11-906b-00155d01c614
State:
MINNESOTA

National Provider Identifier

NPI Number:
1326799081
Certification Date:
2023-09-22

Authorized Person:

Name:
KARLA RENEE MULLINGS
Role:
DIRECTOR OF COMPLIANCE
Phone:

Taxonomy:

Selected Taxonomy:
261QM0850X - Adult Mental Health Clinic/Center
Is Primary:
No
Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
261QR0405X - Substance Use Disorder Rehabilitation Clinic/Center
Is Primary:
Yes

Contacts:

Filings

Name File Date
Annual Report 2024-06-27
Principal Office Address Change 2023-06-30
Annual Report Amendment 2023-06-30
Annual Report 2023-03-02
Reinstatement Certificate of Existence 2022-12-15

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Sources: Kentucky Secretary of State