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  5. COASTAL FOOT & ANKLE WELLNESS CENTER, LLC

COASTAL FOOT & ANKLE WELLNESS CENTER, LLC - Florida Company Profile

Company Details

Entity Name: COASTAL FOOT & ANKLE WELLNESS CENTER, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.

COASTAL FOOT & ANKLE WELLNESS CENTER, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations.
In Florida, LLCs are governed by Title XXXVI, Chapter 605, Florida Revised Limited Liability Company Act
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: 12 Jan 2010 (15 years ago)
Document Number: L10000004472
FEI/EIN Number 27-1667467

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 1740 Tree Blvd Suite 112, ST. AUGUSTINE, FL, 32084, US
Mail Address: 1740 Tree Blvd Suite 112, ST. AUGUSTINE, FL, 32084, US
ZIP code: 32084
County: St. Johns
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1972834760 2010-01-19 2020-12-27 1740 TREE BLVD STE 112, ST AUGUSTINE, FL, 320845720, US 1740 TREE BLVD STE 112, ST AUGUSTINE, FL, 320845720, US

Contacts
Phone +1 904-826-1900
Fax 9048261920

Authorized person
Name DR. RICHARD W JOHNSON
Role OWNER
Phone 9048261900

Taxonomy
Taxonomy Code 213ES0103X - Foot & Ankle Surgery Podiatrist
License Number P02829
State FL
Is Primary Yes

Other Provider Identifiers
Issuer BCBS OF FLORIDA
Number 000NU
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
COASTAL FOOT & ANKLE WELLNESS CENTER 401(K) PLAN 2023 271667467 2024-07-23 COASTAL FOOT & ANKLE WELLNESS CENTER 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621391
Sponsor’s telephone number 9048261900
Plan sponsor’s address 1740 TREE BLVD., SUITE 112, ST. AUGUSTINE, FL, 32084
COASTAL FOOT & ANKLE WELLNESS CENTER 401(K) PLAN 2022 271667467 2023-10-02 COASTAL FOOT & ANKLE WELLNESS CENTER 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621391
Sponsor’s telephone number 9048261900
Plan sponsor’s address 1740 TREE BLVD., SUITE 112, ST. AUGUSTINE, FL, 32084
COASTAL FOOT & ANKLE WELLNESS CENTER 401(K) PLAN 2021 271667467 2023-01-11 COASTAL FOOT & ANKLE WELLNESS CENTER 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621391
Sponsor’s telephone number 9048261900
Plan sponsor’s address 1740 TREE BLVD., SUITE 112, ST. AUGUSTINE, FL, 32084
COASTAL FOOT & ANKLE WELLNESS CENTER 401(K) PLAN 2020 271667467 2021-10-14 COASTAL FOOT & ANKLE WELLNESS CENTER 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621391
Sponsor’s telephone number 9048261900
Plan sponsor’s address 1740 TREE BLVD., SUITE 112, ST. AUGUSTINE, FL, 32084
COASTAL FOOT & ANKLE WELLNESS CENTER 401(K) PLAN 2019 271667467 2020-10-05 COASTAL FOOT & ANKLE WELLNESS CENTER 7
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621391
Sponsor’s telephone number 9048261900
Plan sponsor’s address 200 SOUTHPARK BLVD. SUITE 218, ST. AUGUSTINE, FL, 32086
COASTAL FOOT & ANKLE WELLNESS CENTER 401(K) PLAN 2019 271667467 2021-10-14 COASTAL FOOT & ANKLE WELLNESS CENTER 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621391
Sponsor’s telephone number 9048261900
Plan sponsor’s address 200 SOUTHPARK BLVD. SUITE 218, ST. AUGUSTINE, FL, 32086
COASTAL FOOT & ANKLE WELLNESS CENTER 401(K) PLAN 2018 271667467 2019-07-30 COASTAL FOOT & ANKLE WELLNESS CENTER 7
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621391
Sponsor’s telephone number 9048261900
Plan sponsor’s address 200 SOUTHPARK BLVD. SUITE 218, ST. AUGUSTINE, FL, 32086
COASTAL FOOT & ANKLE WELLNESS CENTER 401(K) PLAN 2018 271667467 2019-10-15 COASTAL FOOT & ANKLE WELLNESS CENTER 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621391
Sponsor’s telephone number 9048261900
Plan sponsor’s address 200 SOUTHPARK BLVD. SUITE 218, ST. AUGUSTINE, FL, 32086
COASTAL FOOT & ANKLE WELLNESS CENTER 401(K) PLAN 2017 271667467 2018-09-17 COASTAL FOOT & ANKLE WELLNESS CENTER 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621391
Sponsor’s telephone number 9048261900
Plan sponsor’s address 200 SOUTHPARK BLVD. SUITE 218, ST. AUGUSTINE, FL, 32086
COASTAL FOOT & ANKLE WELLNESS CENTER 401(K) PLAN 2016 271667467 2017-10-18 COASTAL FOOT & ANKLE WELLNESS CENTER 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621391
Sponsor’s telephone number 9048261900
Plan sponsor’s address 200 SOUTHPARK BLVD. SUITE 218, ST. AUGUSTINE, FL, 32086

Key Officers & Management

Name Role Address
JOHNSON RICHARD WDPM Managing Member 1740 Tree Blvd Suite 112, ST. AUGUSTINE, FL, 32084
CONCHA JOSE MDPM Managing Member 1740 Tree Blvd Suite 112, ST. AUGUSTINE, FL, 32084
Johnson Richard Agent 1740 Tree Blvd Suite 112, ST. AUGUSTINE, FL, 32084

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2021-01-18 1740 Tree Blvd Suite 112, ST. AUGUSTINE, FL 32084 -
CHANGE OF MAILING ADDRESS 2021-01-18 1740 Tree Blvd Suite 112, ST. AUGUSTINE, FL 32084 -
REGISTERED AGENT NAME CHANGED 2021-01-18 Johnson, Richard -
REGISTERED AGENT ADDRESS CHANGED 2021-01-18 1740 Tree Blvd Suite 112, ST. AUGUSTINE, FL 32084 -

Documents

Name Date
ANNUAL REPORT 2025-01-14
ANNUAL REPORT 2024-01-18
ANNUAL REPORT 2023-04-25
ANNUAL REPORT 2022-01-07
ANNUAL REPORT 2021-01-18
ANNUAL REPORT 2020-01-06
ANNUAL REPORT 2019-02-05
ANNUAL REPORT 2018-02-02
AMENDED ANNUAL REPORT 2017-04-18
ANNUAL REPORT 2017-01-16

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
6192057206 2020-04-27 0491 PPP 200 Southpark Blvd., Suite 208, SAINT AUGUSTINE, FL, 32086
Loan Status Date 2021-06-26
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 103800
Loan Approval Amount (current) 103800
Undisbursed Amount 0
Franchise Name -
Lender Location ID 19595
Servicing Lender Name Ameris Bank
Servicing Lender Address 3490 Piedmont Rd NE, Ste 124, ATLANTA, GA, 30305
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address SAINT AUGUSTINE, SAINT JOHNS, FL, 32086-0001
Project Congressional District FL-06
Number of Employees 8
NAICS code 621391
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 19595
Originating Lender Name Ameris Bank
Originating Lender Address ATLANTA, GA
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 104877.81
Forgiveness Paid Date 2021-05-20

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Companies related by address

No other companies in our directory share the same address as COASTAL FOOT & ANKLE WELLNESS CENTER, LLC

Date of last update: 01 Mar 2025

Sources: Florida Department of State

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