| Entity Name: | TREASURE COAST ASSISTED LIVING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Mar 2021 (4 years ago) |
| Document Number: | L21000114755 |
| FEI/EIN Number | 86-3619848 |
| Address: | 1914 21ST, STREET, VERO BEACH, FL, 32960, US |
| Mail Address: | 1914 21ST, STREET, 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 | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659133577 | 2024-01-25 | 2024-07-01 | 1914 21ST ST, VERO BEACH, FL, 329603489, US | 1914 21ST ST, VERO BEACH, FL, 329603489, US | |||||||||||||||||||||||||||
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| Phone | +1 772-567-6769 |
| Fax | 7725675289 |
Authorized person
| Name | PATRICIA PACAUD BREZAULT |
| Role | ADMINISTRATOR |
| Phone | 7725676769 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | LICENSE |
| Number | 13755 |
| State | FL |
| Issuer | MEDICAID |
| Number | 116694600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TREASURE COAST ASSISTED LIVING, LLC dba Ca | Agent | 1914 21ST, STREET, VERO BEACH, FL, 32960 |
| Name | Role | Address |
|---|---|---|
| BREZAULT PATRICIA PAMBR | Authorized Member | 1914 21ST, STREET, VERO BEACH, FL, 32960 |
| Name | Role | Address |
|---|---|---|
| Patricia Pacaud Brezault | Auth | 1914 21ST, STREET, VERO BEACH, FL, 32960 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000136577 | CASTLEWOOD ASSISTED LIVING RESIDENCE | ACTIVE | 2021-10-11 | 2026-12-31 | No data | 1914 21ST STREET, VERO BEACH, FL, 32960 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-02-06 | TREASURE COAST ASSISTED LIVING, LLC dba Castlewood Assisted Living Residence | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-06 | 1914 21ST, STREET, VERO BEACH, FL 32960 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-22 | 1914 21ST, STREET, VERO BEACH, FL 32960 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-22 | 1914 21ST, STREET, VERO BEACH, FL 32960 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-03-22 |
| ANNUAL REPORT | 2022-04-28 |
| Florida Limited Liability | 2021-03-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
