| Entity Name: | COASTAL FAMILY HEALTHCARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 18 Feb 2015 (10 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | L15000030597 |
| FEI/EIN Number | 47-3158007 |
| Address: | 21 Hospital Drive, Ste. 280, Palm Coast, FL 32164 |
| Mail Address: | 21 Hospital Drive, Ste. 280, Palm Coast, FL 32164 |
| ZIP code: | 32164 |
| County: | Flagler |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033500624 | 2015-02-18 | 2015-02-18 | 21 HOSPITAL DR, SUITE 280, PALM COAST, FL, 321642452, US | 21 HOSPITAL DR, SUITE 280, PALM COAST, FL, 321642452, US | |||||||||||||
|
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| Phone | +1 386-437-4711 |
Authorized person
| Name | JERRY D LEVENTHAL |
| Role | SOLE MBR |
| Phone | 3864374711 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Di Capua, Joseph J | Agent | 8100 Royal Palm Blvd., Ste. 102, Coral Springs, FL 33065 |
| Name | Role | Address |
|---|---|---|
| Leventhal, Jerry D, MD | Manager | 21 Hospital Drive, Ste. 280 Palm Coast, FL 32164 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-03-13 | 21 Hospital Drive, Ste. 280, Palm Coast, FL 32164 | No data |
| CHANGE OF MAILING ADDRESS | 2018-03-13 | 21 Hospital Drive, Ste. 280, Palm Coast, FL 32164 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-03-13 | Di Capua, Joseph J | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-03-13 | 8100 Royal Palm Blvd., Ste. 102, Coral Springs, FL 33065 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-01-03 |
| ANNUAL REPORT | 2018-03-13 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-03-28 |
| Florida Limited Liability | 2015-02-18 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
