| Entity Name: | COASTAL BEHAVIOR ANALYSIS, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Sep 2010 (14 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 12 Sep 2022 (2 years ago) |
| Document Number: | L10000101395 |
| FEI/EIN Number | 273655057 |
| Address: | 1515 Indian River Boulevard, Vero Beach, FL, 32960, US |
| Mail Address: | 1515 Indian River Boulevard, Vero Beach, FL, 32960, US |
| ZIP code: | 32960 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932408143 | 2011-03-28 | 2016-06-15 | 1515 INDIAN RIVER BLVD, SUITE A210, VERO BEACH, FL, 329605639, US | 1515 INDIAN RIVER BLVD, SUITE A210, VERO BEACH, FL, 329605639, US | |||||||||||||||||||||||
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| Phone | +1 774-774-8224 |
| Fax | 7727748275 |
Authorized person
| Name | MR. JOHN PIERCE KELLER JR. |
| Role | MANAGING MEMBER |
| Phone | 7727130108 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| License Number | 1042028 |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003810000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ARMS RENEE K | Agent | 1515 Indian River Boulevard, Vero Beach, FL, 32960 |
| Name | Role | Address |
|---|---|---|
| Renee K. Arms, as Trustee of the Renee Kel | Auth | 1515 Indian River Boulevard, Vero Beach, FL, 32960 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-16 | 1515 Indian River Boulevard, Suite A-210, Vero Beach, FL 32960 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-16 | 1515 Indian River Boulevard, Suite A-210, Vero Beach, FL 32960 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-16 | 1515 Indian River Boulevard, Suite A-210, Vero Beach, FL 32960 | No data |
| LC AMENDMENT | 2022-09-12 | No data | No data |
| LC AMENDMENT | 2022-04-04 | No data | No data |
| LC AMENDMENT | 2022-01-11 | No data | No data |
| LC AMENDMENT | 2017-08-21 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-15 |
| ANNUAL REPORT | 2023-02-16 |
| LC Amendment | 2022-09-12 |
| LC Amendment | 2022-04-04 |
| ANNUAL REPORT | 2022-03-09 |
| LC Amendment | 2022-01-11 |
| ANNUAL REPORT | 2021-03-09 |
| ANNUAL REPORT | 2020-02-18 |
| ANNUAL REPORT | 2019-02-05 |
| ANNUAL REPORT | 2018-01-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
