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COASTAL CARE RESIDENCE LLC - Florida Company Profile

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Company Details

Entity Name: COASTAL CARE RESIDENCE LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 15 Jun 2023 (2 years ago)
Document Number: L23000289264
FEI/EIN Number 931884486
Address: 235 APOLLO BEACH BLVD, 182, APOLLO BEACH, FL, 33572, US
Mail Address: 235 APOLLO BEACH BLVD, 182, APOLLO BEACH, FL, 33572, US
ZIP code: 33572
City: Apollo Beach
County: Hillsborough
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
JORDAN CHEVELLE R Chief Executive Officer 235 APOLLO BEACH BLVD #182, APOLLO BEACH, FL, 33572
JORDAN CHEVELLE R Agent 235 APOLLO BEACH BLVD, APOLLO BEACH, FL, 33572

National Provider Identifier

NPI Number:
1336927870
Certification Date:
2024-04-25

Authorized Person:

Name:
CHEVELLE R JORDAN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QD1600X - Developmental Disabilities Clinic/Center
Is Primary:
No
Selected Taxonomy:
251C00000X - Developmentally Disabled Services Day Training Agency
Is Primary:
Yes

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G25000077451 COASTAL CARE ADT ACTIVE 2025-06-17 2030-12-31 - 81 7TH AVE NE, RUSKIN, FL, 33570
G25000077464 COASTAL HOME CARE & ADT ACTIVE 2025-06-17 2030-12-31 - 81 7TH AVE NE, RUSKIN, FL, 33570

Documents

Name Date
ANNUAL REPORT 2024-04-30
Florida Limited Liability 2023-06-15

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Date of last update: 02 Aug 2025

Sources: Florida Department of State