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COASTAL CARE SVCS TPA, INC - Florida Company Profile

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Company Details

Entity Name: COASTAL CARE SVCS TPA, INC
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 22 May 2020 (5 years ago)
Document Number: P20000038749
FEI/EIN Number 85-1141587
Address: 1200 NW 78th Avenue, DORAL, FL, 33126, US
Mail Address: 1200 NW 78th Avenue, DORAL, FL, 33126, US
ZIP code: 33126
City: Miami
County: Miami-Dade
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
CHAMIZO JORGE President 1200 NW 78th Avenue, DORAL, FL, 33126
GARCIA YSEL Vice President 1200 NW 78th Avenue, DORAL, FL, 33126
FORTE YHANEYA Secretary 1200 NW 78th Avenue, DORAL, FL, 33126
GARCIA YSEL Agent 1200 NW 78th Avenue, DORAL, FL, 33126

National Provider Identifier

NPI Number:
1700483435
Certification Date:
2021-05-24

Authorized Person:

Name:
YSEL M GARCIA
Role:
SENIOR VICE PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
251B00000X - Case Management Agency
Is Primary:
Yes

Contacts:

Fax:
8554810606
Fax:
8664810606

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2021-01-29 1200 NW 78th Avenue, Suite #100, DORAL, FL 33126 -
CHANGE OF MAILING ADDRESS 2021-01-29 1200 NW 78th Avenue, Suite #100, DORAL, FL 33126 -
REGISTERED AGENT ADDRESS CHANGED 2021-01-29 1200 NW 78th Avenue, Suite #100, DORAL, FL 33126 -

Documents

Name Date
ANNUAL REPORT 2025-02-12
ANNUAL REPORT 2024-01-09
ANNUAL REPORT 2023-03-02
ANNUAL REPORT 2022-03-03
ANNUAL REPORT 2021-01-29
Domestic Profit 2020-05-22

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Date of last update: 03 Aug 2025

Sources: Florida Department of State