| Entity Name: | FORGOTTEN COAST SPEECH, LANGUAGE AND SWALLOWING REHAB, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Sep 2019 (5 years ago) |
| Document Number: | L19000223452 |
| FEI/EIN Number | 84-3039965 |
| Address: | 42 EVENING STAR DR, CRAWFORDVILLE, FL, 32327, US |
| Mail Address: | 42 EVENING STAR DR, CRAWFORDVILLE, FL, 32327, US |
| ZIP code: | 32327 |
| County: | Wakulla |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1225688047 | 2019-09-13 | 2020-09-29 | 42 EVENING STAR DR, CRAWFORDVILLE, FL, 323270686, US | 42 EVENING STAR DR, CRAWFORDVILLE, FL, 323270686, US | |||||||||||||||||||
|
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| Phone | +1 352-538-6177 |
Authorized person
| Name | VALERIE DAWN MASON |
| Role | SPEECH-LANGUAGE PATHOLOGIST/OWNER |
| Phone | 3525386177 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 015670500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MASON VALERIE | Agent | 42 EVENING STAR DR, CRAWFORDVILLE, FL, 32327 |
| Name | Role | Address |
|---|---|---|
| MASON VALERIE | Manager | 42 EVENING STAR DR, CRAWFORDVILLE, FL, 32327 |
| Name | Role | Address |
|---|---|---|
| McInnis Linda | Officer | 42 EVENING STAR DR, CRAWFORDVILLE, FL, 32327 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-04-13 |
| ANNUAL REPORT | 2020-06-07 |
| Florida Limited Liability | 2019-09-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
