| Entity Name: | COASTLINE MENTAL HEALTH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 05 Aug 2024 (6 months ago) |
| Document Number: | L24000342834 |
| FEI/EIN Number | 99-4392458 |
| Address: | 1723 PINE AVE, NICEVILLE, FL 32578 |
| Mail Address: | 1723 PINE AVE, NICEVILLE, FL 32578 |
| ZIP code: | 32578 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811729015 | 2024-08-15 | 2024-08-15 | 1723 PINE AVE, NICEVILLE, FL, 325784600, US | 1723 PINE AVE, NICEVILLE, FL, 325784600, US | |||||||||||||
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| Phone | +1 850-368-4670 |
Authorized person
| Name | MR. BRIAN WADE PULLAM |
| Role | OWNER |
| Phone | 8503684670 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PULLAM, BRIAN W | Agent | 1723 PINE AVE, NICEVILLE, FL 32578 |
| Name | Role | Address |
|---|---|---|
| PULLAM, BRIAN W | Manager | 1723 PINE AVE, NICEVILLE, FL 32578 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-06 |
| Florida Limited Liability | 2024-08-05 |
Date of last update: 07 Feb 2025
Sources: Florida Department of State
