| Entity Name: | COASTAL COMMUNITY HEALTH SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Non-Profit |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 26 Mar 2024 (a year ago) |
| Document Number: | F24000001903 |
| FEI/EIN Number |
461859206
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 22385 FLORA PARKE CROSSING, UNIT 2, LOT 2, FERNANDINA BEACH, FL, 32085, US |
| Mail Address: | 22385 FLORA PARKE CROSSING, UNIT 2, LOT 2, FERNANDINA BEACH, FL, 32085, US |
| ZIP code: | 32085 |
| County: | St. Johns |
| Place of Formation: | GEORGIA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851131874 | 2024-05-28 | 2024-05-28 | 100 PROFESSIONAL CENTER DR, BRUNSWICK, GA, 315256743, US | 22385 FLORA PARK CROSSING DRIVE, FERNANDINA BEACH, FL, 32034, US | |||||||||||||||||
|
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| Phone | +1 912-574-5075 |
| Phone | +1 904-404-8641 |
| Fax | 9042273246 |
Authorized person
| Name | DR. KAVANAUGH CHANDLER |
| Role | CEO |
| Phone | 9122758028 |
Taxonomy
| Taxonomy Code | 261QF0400X - Federally Qualified Health Center (FQHC) |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CHANDLER KAVANAUGH | President | 100 PROFESSIONAL DRIVE, BRUNSWICK, GA, 31525 |
| STOLL MARTINA | Treasurer | 100 PROFESSIONAL DRIVE, BRUNSWICK, GA, 31525 |
| SAMS EUNICE | Secretary | 25 COUNTRY CLUB COURT, ST SIMONS ISLAND, GA, 31522 |
| WATTS JOSIAH | Chairman | 505 BAISDEN LANE, ST SIMONS ISLAND, GA, 31522 |
| MUSTARI JEFFREY ESQ | Agent | 301 W BAY STREET, STE 14152, JACKSONVILLE, FL, 32202 |
| Name | Date |
|---|---|
| Foreign Non-Profit | 2024-03-26 |
Date of last update: 01 Mar 2025
Sources: Florida Department of State
