| Entity Name: | EMERALD COAST WELLNESS CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 17 Dec 2009 (15 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | L09000119714 |
| FEI/EIN Number | 271508094 |
| Address: | 128 JOHN KING RD, CRESTVIEW, FL, 32539, US |
| Mail Address: | 128 JOHN KING RD, CRESTVIEW, FL, 32539, US |
| ZIP code: | 32539 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417287855 | 2010-01-07 | 2015-09-02 | 138 BAYWIND DR, NICEVILLE, FL, 325784800, US | 138 BAYWIND DR, NICEVILLE, FL, 325784800, US | |||||||||||||||||||||||||||||
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| Phone | +1 850-398-4155 |
| Fax | 8503984142 |
Authorized person
| Name | DR. HENRY ALEXANDER BOILINI |
| Role | PSYCHIATRIST |
| Phone | 8505435678 |
Taxonomy
| Taxonomy Code | 2084P0805X - Geriatric Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008056800 |
| State | FL |
| Name | Role |
|---|---|
| UNITED STATES CORPORATION AGENTS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| BOILINI HENRY | Managing Member | 128 JOHN KING RD, CRESTVIEW, FL, 32539 |
| BOILINI MARGARET | Managing Member | 128 JOHN KING RD, CRESTVIEW, FL, 32539 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000056841 | EMERALD COAST WELLNESS CENTER | EXPIRED | 2010-06-21 | 2015-12-31 | No data | 128 JOHN KING RD, SUITE 14, CRESTVIEW, FL, 32539 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-02 | 476 RIVERSIDE AVE., JACKSONVILLE, FL 32202 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-03-26 | 128 JOHN KING RD, Suite 18, CRESTVIEW, FL 32539 | No data |
| CHANGE OF MAILING ADDRESS | 2015-03-26 | 128 JOHN KING RD, Suite 18, CRESTVIEW, FL 32539 | No data |
| LC AMENDMENT | 2012-08-27 | No data | No data |
| LC AMENDMENT | 2011-11-07 | No data | No data |
| REINSTATEMENT | 2011-02-15 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-03-26 |
| ANNUAL REPORT | 2014-04-29 |
| ANNUAL REPORT | 2013-04-09 |
| ANNUAL REPORT | 2012-08-30 |
| LC Amendment | 2012-08-27 |
| LC Amendment | 2011-11-07 |
| REINSTATEMENT | 2011-02-15 |
| Florida Limited Liability | 2009-12-17 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
