| Entity Name: | EMERALD COAST REHABILITATION CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 18 Sep 2008 (16 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 22 Feb 2016 (9 years ago) |
| Document Number: | L08000089131 |
| FEI/EIN Number | 26-3411532 |
| Address: | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL 33401 |
| Mail Address: | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL 33401 |
| ZIP code: | 33401 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891799623 | 2005-06-09 | 2014-02-27 | 1675 PALM BEACH LAKES BLVD, SUITE 900, WEST PALM BEACH, FL, 33401, US | 114 3RD ST SE, FORT WALTON BEACH, FL, 325485401, US | |||||||||||||||||||||||||||
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| Phone | +1 561-801-7600 |
| Phone | +1 850-243-6134 |
| Fax | 8502439759 |
Authorized person
| Name | HOWARD JAFFE |
| Role | PRESIDENT |
| Phone | 2153466454 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF11410961 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 021290300 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Jaffe, Howard | Manager | 1665 Palm Beach Lakes Blvd., Suite 400 West Palm Beach, FL 33401 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000108026 | EMERALD COAST CENTER | ACTIVE | 2015-10-22 | 2025-12-31 | No data | 114 THIRD STREET, S.E, FT. WALTON BEACH, FL, 33401 |
| G09104900011 | EMERALD COAST CENTER | EXPIRED | 2009-04-12 | 2014-12-31 | No data | 114 THIRD STREET S.E., FT WALTON BEACH, FL, 32546 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-01 | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL 33401 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-01 | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL 33401 | No data |
| LC STMNT OF RA/RO CHG | 2016-02-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-02-22 | C T CORPORATION SYSTEM | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-02-22 | 1200 SOUTH PINE ISLAND ROAD, SUITE 1550, PLANTATION, FL 33324 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-01 |
| ANNUAL REPORT | 2023-02-25 |
| ANNUAL REPORT | 2022-03-25 |
| AMENDED ANNUAL REPORT | 2021-06-15 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-04-22 |
| ANNUAL REPORT | 2019-03-28 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-04-12 |
| ANNUAL REPORT | 2016-04-29 |
Date of last update: 26 Jan 2025
Sources: Florida Department of State
