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  5. COASTAL DETOX, INC

COASTAL DETOX, INC

Company Details

Entity Name: COASTAL DETOX, INC
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 10 Dec 2014 (10 years ago)
Last Event: AMENDMENT
Event Date Filed: 02 Mar 2015 (10 years ago)
Document Number: P14000098611
FEI/EIN Number 47-2527897
Address: 1131 SE INDIAN STREET, STUART, FL 34997
Mail Address: 1131 SE INDIAN STREET, STUART, FL 34997
ZIP code: 34997
County: Martin
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1598130098 2015-12-09 2024-10-01 3007 SW MARTIN DOWNS BLVD, PALM CITY, FL, 349902644, US 1131 SE INDIAN ST, STUART, FL, 349975688, US

Contacts
Phone +1 772-612-0130

Authorized person
Name CHRISTINA TUCKER
Role CHIEF EXECUTIVE OFFICER
Phone 7722191355

Taxonomy
Taxonomy Code 111NX0100X - Occupational Health Chiropractor
Is Primary No
Taxonomy Code 2084P0800X - Psychiatry Physician
Is Primary No
Taxonomy Code 225700000X - Massage Therapist
Is Primary No
Taxonomy Code 284300000X - Special Hospital
Is Primary No
Taxonomy Code 324500000X - Substance Abuse Rehabilitation Facility
Is Primary Yes
Taxonomy Code 363A00000X - Physician Assistant
Is Primary No
Taxonomy Code 363AM0700X - Medical Physician Assistant
Is Primary No
Taxonomy Code 363LF0000X - Family Nurse Practitioner
Is Primary No

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
549300IS1B1IIGC6Y428 P14000098611 US-FL GENERAL ACTIVE No data

Addresses
Legal C/O TUCKER, CHRISTINA, 1131 SE INDIAN STREET, STUART, US-FL, US, 34997
Headquarters 1131 SE Indian Street, Stuart, US-FL, US, 34997

Registration details
Registration Date 2020-03-10
Last Update 2023-08-04
Status LAPSED
Next Renewal 2021-02-05
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As P14000098611

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
401(K) PROFIT SHARING PLAN FOR EMPLOYEES OF COASTAL DETOX, INC. 2023 472527897 2024-09-17 COASTAL DETOX, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-11-01
Business code 624310
Sponsor’s telephone number 7722191355
Plan sponsor’s address 1131 SE INDIAN ST., STUART, FL, 34997

Signature of
Role Plan administrator
Date 2024-09-17
Name of individual signing WENDY RIVERS
Valid signature Filed with authorized/valid electronic signature
401(K) PROFIT SHARING PLAN FOR EMPLOYEES OF COASTAL DETOX, INC. 2022 472527897 2023-09-21 COASTAL DETOX, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-11-01
Business code 624310
Sponsor’s telephone number 7722191355
Plan sponsor’s address 1131 SE INDIAN ST, STUART, FL, 34997

Signature of
Role Plan administrator
Date 2023-09-21
Name of individual signing WENDY RIVERS
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF COASTAL DETOX, INC. 2021 472527897 2022-10-21 COASTAL DETOX, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-11-01
Business code 624310
Sponsor’s telephone number 7722191355
Plan sponsor’s address 3007 SW MARTIN DOWNS BLVD, PALM CITY, FL, 349902644

Signature of
Role Plan administrator
Date 2022-10-21
Name of individual signing WENDY RIVERS
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF COASTAL DETOX, INC. 2020 472527897 2021-08-24 COASTAL DETOX, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-11-01
Business code 624310
Sponsor’s telephone number 7722191355
Plan sponsor’s address 3007 SW MARTIN DOWNS BLVD, PALM CITY, FL, 349902644

Signature of
Role Plan administrator
Date 2021-08-24
Name of individual signing WENDY RIVERS
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF COASTAL DETOX, INC. 2019 472527897 2020-07-29 COASTAL DETOX, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-11-01
Business code 624310
Sponsor’s telephone number 7722191355
Plan sponsor’s address 3007 SW MARTIN DOWNS BLVD, PALM CITY, FL, 349902644

Signature of
Role Plan administrator
Date 2020-07-29
Name of individual signing WENDY RIVERS
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF COASTAL DETOX, INC 2019 472527897 2020-06-26 COASTAL DETOX INC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-11-01
Business code 624310
Sponsor’s telephone number 7726170853
Plan sponsor’s address 1131 SE INDIAN ST, STUART, FL, 349975765

Signature of
Role Plan administrator
Date 2020-06-26
Name of individual signing WENDY RIVERS
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF COASTAL DETOX, INC. 2018 472527897 2019-09-25 COASTAL DETOX, INC. 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-11-01
Business code 624310
Sponsor’s telephone number 7722191355
Plan sponsor’s address 1131 SE INDIAN ST., STUART, FL, 34997

Signature of
Role Plan administrator
Date 2019-09-25
Name of individual signing VALLIRIE MOLINA
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
TUCKER, CHRISTINA Agent 1131 SE INDIAN STREET, STUART, FL 34997

Chief Executive Officer

Name Role Address
TUCKER, CHRISTINA Chief Executive Officer 1131 SE INDIAN STREET, STUART, FL 34997

Vice President

Name Role Address
OGRADY, JOSEPH Vice President 1131 SE INDIAN STREET, STUART, FL 34997

Director

Name Role Address
Crawford, Dean Director 1131 SE INDIAN STREET, STUART, FL 34997
Crawford, Laura Director 1131 SE INDIAN STREET, STUART, FL 34997

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2019-04-15 1131 SE INDIAN STREET, STUART, FL 34997 No data
REGISTERED AGENT ADDRESS CHANGED 2019-04-15 1131 SE INDIAN STREET, STUART, FL 34997 No data
CHANGE OF PRINCIPAL ADDRESS 2015-08-25 1131 SE INDIAN STREET, STUART, FL 34997 No data
AMENDMENT 2015-03-02 No data No data

Documents

Name Date
ANNUAL REPORT 2024-02-15
ANNUAL REPORT 2023-02-14
ANNUAL REPORT 2022-01-27
ANNUAL REPORT 2021-02-11
ANNUAL REPORT 2020-04-23
ANNUAL REPORT 2019-04-15
AMENDED ANNUAL REPORT 2018-04-26
ANNUAL REPORT 2018-04-16
ANNUAL REPORT 2017-02-13
ANNUAL REPORT 2016-03-04

Related by officers

TUCKER, CHRISTINA

DREAM CENTER FOR RECOVERY INC. RECOVERY HOLDINGS OF FLORIDA, LLC CHRISTINACO LLC THE COMMONS AT INDIAN STREET PROPERTY OWNERS ASSOCIATION, INC. GUNNAR INDUSTRIES, INC. PHYSICIAN'S GROUP OF THE TREASURE COAST, LLC A FRESH START LIVING, LLC TUCKER COMMONS, LLC TUCKER REALTY, LLC

OGRADY, JOSEPH

CHRISTINACO LLC PHYSICIAN'S GROUP OF THE TREASURE COAST, LLC

Related by address

1131 SE INDIAN STREET, STUART, FL 34997

DREAM CENTER FOR RECOVERY INC. TUCKER COMMONS, LLC

1131 SE INDIAN STREET, STUART, FL 34997

DREAM CENTER FOR RECOVERY INC. TUCKER COMMONS, LLC

Date of last update: 21 Jan 2025

Sources: Florida Department of State

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