| Entity Name: | COSTON ENTERPRISES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Jan 2019 (6 years ago) |
| Document Number: | L19000027637 |
| FEI/EIN Number | 203823731 |
| Address: | 12205 FAWN BRINDLE ST, RIVERVIEW, FL, 33578, US |
| Mail Address: | 12205 FAWN BRINDLE ST, RIVERVIEW, FL, 33578, US |
| ZIP code: | 33578 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558528521 | 2008-05-19 | 2008-05-19 | PO BOX 2232, VALRICO, FL, 335952232, US | 1907 LANDSIDE DR, VALRICO, FL, 335944421, US | |||||||||||||||||||||
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| Phone | +1 813-383-4674 |
| Fax | 8133834674 |
Authorized person
| Name | MR. DIANO R COSTON SR. |
| Role | OWNER |
| Phone | 8133834674 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 992277600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| COSTON DIANO RSR | Agent | 12205 FAWN BRINDLE ST, RIVERVIEW, FL, 33578 |
| Name | Role | Address |
|---|---|---|
| COSTON DIANO RSR | Chief Executive Officer | 12205 FAWN BRINDLE ST, RIVERVIEW, FL, 33578 |
| Name | Role | Address |
|---|---|---|
| COSTON MICHELLE R | Chief Operating Officer | 12205 FAWN BRINDLE ST, RIVERVIEW, FL, 33578 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-04-14 | 12205 FAWN BRINDLE ST, RIVERVIEW, FL 33578 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-02-05 | 12205 FAWN BRINDLE ST, RIVERVIEW, FL 33578 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-02-11 |
| ANNUAL REPORT | 2022-04-14 |
| ANNUAL REPORT | 2021-03-13 |
| ANNUAL REPORT | 2020-05-15 |
| Florida Limited Liability | 2019-01-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
