| Entity Name: | COASTAL NURSECARE OF FLORIDA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 Aug 2001 (23 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 09 Nov 2017 (7 years ago) |
| Document Number: | P01000082401 |
| FEI/EIN Number | 593739723 |
| Address: | 2300 Warrenville Rd Suite 100, Downers Grove, IL, 60515, US |
| Mail Address: | 2300 Warrenville Rd Suite 100, Downers Grove, IL, 60515, US |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | COASTAL NURSECARE OF FLORIDA, INC., ALABAMA | 000-920-374 | ALABAMA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407841729 | 2005-09-13 | 2023-04-10 | 2160 CREIGHTON ROAD, PENSACOLA, FL, 32504, US | 2160 CREIGHTON RD, PENSACOLA, FL, 325047218, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 850-475-9000 |
| Fax | 8504759330 |
Authorized person
| Name | DARBY ANDERSON |
| Role | EVP CGRO |
| Phone | 6302963443 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | 299991520 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 684119896 |
| State | FL |
| Issuer | MEDICAID |
| Number | 685500800 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | JP4 |
| State | FL |
| Issuer | MEDICAID |
| Number | 650996700 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Allison Dirk | President | 6303 Cowboys Way Suite 600, Frisco, TX, 75034 |
| Name | Role | Address |
|---|---|---|
| POFF BRIAN | Secretary | 6303 COWBOYS WAY SUITE 600, FRISCO, TX, 75034 |
| Name | Role | Address |
|---|---|---|
| Monahan Brian | Vice President | 6303 Cowboys Way Suite 600, Frisco, TX, 75034 |
| Name | Role | Address |
|---|---|---|
| Monahan Brian | o | 6303 Cowboys Way Suite 600, Frisco, TX, 75034 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000020767 | ADDUS HOMECARE | ACTIVE | 2023-02-13 | 2028-12-31 | No data | 2300 WARRENVILLE RD., STE 100, DOWNERS GROVE, DE, 60515 |
| G19000084199 | CARESTAFF | EXPIRED | 2019-08-08 | 2024-12-31 | No data | 442 MIMOSA DR., ST. SIMONS, GA, 31522 |
| G13000066790 | CARESTAFF | EXPIRED | 2013-07-02 | 2018-12-31 | No data | 2160 CREIGHTON RD., PENSACOLA, FL, 32504-7218 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-07 | 2300 Warrenville Rd Suite 100, Downers Grove, IL 60515 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-07 | 2300 Warrenville Rd Suite 100, Downers Grove, IL 60515 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-03 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-01-03 | CORPORATION SERVICE COMPANY | No data |
| REINSTATEMENT | 2017-11-09 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| MERGER | 2014-12-01 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 0. MERGER NUMBER 100000147091 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-02-07 |
| Reg. Agent Change | 2023-01-03 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-01-20 |
| AMENDED ANNUAL REPORT | 2019-06-03 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-01-15 |
| REINSTATEMENT | 2017-11-09 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
