| Entity Name: | COACHING BEHAVIORAL ALTERNATIVES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 26 Dec 2006 (18 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | P06000156583 |
| FEI/EIN Number | 208111205 |
| Address: | 615 RIVERVIEW BLVD., UPSTAIRS # 2, DAYTONA BEACH, FL, 32118 |
| Mail Address: | 615 RIVERVIEW BLVD., UPSTAIRS # 2, DAYTONA BEACH, FL, 32118 |
| ZIP code: | 32118 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780754747 | 2006-11-08 | 2010-05-03 | 615 RIVERVIEW BLVD, DAYTONA BEACH, FL, 321183840, US | 615 RIVERVIEW BLVD, DAYTONA BEACH, FL, 321183840, US | |||||||||||||||||||||||||||||
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| Phone | +1 386-253-4131 |
| Fax | 3869479607 |
Authorized person
| Name | PATRICIA MARSHALL |
| Role | BEHAVIOR ANALYST |
| Phone | 3862534131 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 686939498 |
| State | FL |
| Issuer | MEDICAID |
| Number | 686939496 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARSHALL CHARLOTTE P | Agent | 615 RIVERVIEW BLVD., DAYTONA BEACH, FL, 32118 |
| Name | Role | Address |
|---|---|---|
| MARSHALL CHARLOTTE P | Manager | 615 RIVERVIEW BLVD.UPSTAIRS # 2, DAYTONA BEACH, FL, 32118 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-01-26 | 615 RIVERVIEW BLVD., UPSTAIRS # 2, DAYTONA BEACH, FL 32118 | No data |
| CHANGE OF MAILING ADDRESS | 2010-01-26 | 615 RIVERVIEW BLVD., UPSTAIRS # 2, DAYTONA BEACH, FL 32118 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-01-26 | 615 RIVERVIEW BLVD., UPSTAIRS # 2, DAYTONA BEACH, FL 32118 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-02-26 |
| ANNUAL REPORT | 2014-03-26 |
| ANNUAL REPORT | 2013-01-24 |
| ANNUAL REPORT | 2012-01-13 |
| ANNUAL REPORT | 2011-01-06 |
| ANNUAL REPORT | 2010-01-26 |
| ANNUAL REPORT | 2009-01-05 |
| ANNUAL REPORT | 2008-03-07 |
| Domestic Profit | 2006-12-26 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
