| Entity Name: | COASTAL PSYCHIATRIC WALK-IN CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 31 Aug 2023 (a year ago) |
| Document Number: | P23000063647 |
| FEI/EIN Number | 93-3196079 |
| Address: | 1335 VALENTINE ST, MELBOURNE, FL 32901 |
| Mail Address: | 1335 VALENTINE ST, MELBOURNE, FL 32901 |
| ZIP code: | 32901 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497531529 | 2023-09-05 | 2023-09-05 | 1335 VALENTINE ST, MELBOURNE, FL, 329013127, US | 1335 VALENTINE ST, MELBOURNE, FL, 329013127, US | |||||||||||||||
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| Phone | +1 321-586-5444 |
| Fax | 3213199712 |
Authorized person
| Name | DR. JESSICA KARLE |
| Role | CEO |
| Phone | 3215865444 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| KARLE, JESSICA | Agent | 1335 VALENTINE ST, MELBOURNE, FL 32901 |
| Name | Role | Address |
|---|---|---|
| KARLE, JESSICA | Chief Executive Officer | 1335 VALENTINE ST, MELBOURNE, FL 32901 |
| Name | Role | Address |
|---|---|---|
| KARLE, STEPHEN | Chief Operating Officer | 1335 VALENTINE ST, MELBOURNE, FL 32901 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000105707 | COASTAL PSYCHIATRIC URGENT CARE | ACTIVE | 2023-09-06 | 2028-12-31 | No data | 1335 VALENTINE ST, MELBOURNE, FL, 32901 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-29 |
| Domestic Profit | 2023-08-31 |
Date of last update: 09 Jan 2025
Sources: Florida Department of State
