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MELBOURNE KIDNEY CENTER, INC.

Company Details

Entity Name: MELBOURNE KIDNEY CENTER, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Inactive
Date Filed: 01 Nov 1977 (47 years ago)
Document Number: 740678
FEI/EIN Number 591867582
Address: 1400 SOUTH APOLLO BLVD., MELBOURNE, FL, 32901-3145
Mail Address: 1400 SOUTH APOLLO BLVD., MELBOURNE, FL, 32901-3145
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1104823731 2005-06-28 2010-12-22 280 N WICKHAM RD, MELBOURNE, FL, 329358650, US 280 N WICKHAM RD, MELBOURNE, FL, 329358650, US

Contacts
Phone +1 321-308-5005
Fax 3213085002

Authorized person
Name MRS. SADALIA BARTMAN GROSS
Role ADMINISTRATOR
Phone 3217240431

Taxonomy
Taxonomy Code 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MELBOURNE KIDNEY CENTER, INC. EMPLOYEE PENSION BENEFIT PLAN 2014 591867582 2017-05-15 MELBOURNE KIDNEY CENTER, INC. 73
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-07-01
Business code 621492
Sponsor’s telephone number 3217240461
Plan sponsor’s address 1400 SOUTH APOLLO BOULEVARD, MELBOURNE, FL, 32901

Signature of
Role Plan administrator
Date 2017-05-15
Name of individual signing MICHAEL HSU
Valid signature Filed with authorized/valid electronic signature
MELBOURNE KIDNEY CENTER, INC. EMPLOYEE PENSION BENEFIT PLAN 2013 591867582 2014-07-23 MELBOURNE KIDNEY CENTER, INC. 77
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-07-01
Business code 621492
Sponsor’s telephone number 3217240461
Plan sponsor’s address 1400 SOUTH APOLLO BOULEVARD, MELBOURNE, FL, 32901

Signature of
Role Plan administrator
Date 2014-07-23
Name of individual signing NORMA ABARE
Valid signature Filed with authorized/valid electronic signature
MELBOURNE KIDNEY CENTER, INC. EMPLOYEE PENSION BENEFIT PLAN 2012 591867582 2013-07-24 MELBOURNE KIDNEY CENTER, INC. 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-07-01
Business code 621492
Sponsor’s telephone number 3217240461
Plan sponsor’s address 1400 SOUTH APOLLO BOULEVARD, MELBOURNE, FL, 329013145

Signature of
Role Plan administrator
Date 2013-07-24
Name of individual signing NORMA ABARE
Valid signature Filed with authorized/valid electronic signature
MELBOURNE KIDNEY CENTER, INC. EMPLOYEE PENSION BENEFIT PLAN 2011 591867582 2012-08-08 MELBOURNE KIDNEY CENTER, INC. 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-07-01
Business code 621492
Sponsor’s telephone number 3217240461
Plan sponsor’s address 1400 SOUTH APOLLO BOULEVARD, MELBOURNE, FL, 32901

Plan administrator’s name and address
Administrator’s EIN 591867582
Plan administrator’s name MELBOURNE KIDNEY CENTER, INC.
Plan administrator’s address 1400 SOUTH APOLLO BOULEVARD, MELBOURNE, FL, 32901
Administrator’s telephone number 3217240461

Signature of
Role Plan administrator
Date 2012-08-08
Name of individual signing NORMA ABARE
Valid signature Filed with authorized/valid electronic signature
MELBOURNE KIDNEY CENTER, INC. EMPLOYEE PENSION BENEFIT PLAN 2010 591867582 2011-10-05 MELBOURNE KIDNEY CENTER, INC. 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-07-01
Business code 621492
Sponsor’s telephone number 3217240461
Plan sponsor’s address 1400 SOUTH APOLLO BOULEVARD, MELBOURNE, FL, 32901

Plan administrator’s name and address
Administrator’s EIN 591867582
Plan administrator’s name MELBOURNE KIDNEY CENTER, INC.
Plan administrator’s address 1400 SOUTH APOLLO BOULEVARD, MELBOURNE, FL, 32901
Administrator’s telephone number 3217240461

Signature of
Role Plan administrator
Date 2011-10-05
Name of individual signing NORMA ABARE
Valid signature Filed with authorized/valid electronic signature
MELBOURNE KIDNEY CENTER, INC. EMPLOYEE PENSION BENEFIT PLAN 2010 591867582 2011-09-28 MELBOURNE KIDNEY CENTER, INC. 76
Three-digit plan number (PN) 001
Effective date of plan 1985-07-01
Business code 621492
Sponsor’s telephone number 3217240461
Plan sponsor’s address 1400 SOUTH APOLLO BOULEVARD, MELBOURNE, FL, 32901

Plan administrator’s name and address
Administrator’s EIN 591867582
Plan administrator’s name MELBOURNE KIDNEY CENTER, INC.
Plan administrator’s address 1400 SOUTH APOLLO BOULEVARD, MELBOURNE, FL, 32901
Administrator’s telephone number 3217240461
MELBOURNE KIDNEY CENTER, INC. EMPLOYEE PENSION BENEFIT PLAN 2009 591867582 2010-08-09 MELBOURNE KIDNEY CENTER, INC. 80
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-07-01
Business code 621492
Sponsor’s telephone number 3217240461
Plan sponsor’s address 1400 SOUTH APOLLO BOULEVARD, MELBOURNE, FL, 32901

Plan administrator’s name and address
Administrator’s EIN 591867582
Plan administrator’s name MELBOURNE KIDNEY CENTER, INC.
Plan administrator’s address 1400 SOUTH APOLLO BOULEVARD, MELBOURNE, FL, 32901
Administrator’s telephone number 3217240461

Signature of
Role Plan administrator
Date 2010-08-09
Name of individual signing NORMA ABARE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-08-09
Name of individual signing NORMA ABARE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DETTMER, DALE A. Agent 304 SOUTH HARBOR CITY BLVD, MELBOURNE, FL, 32901

President

Name Role Address
KROENING, JACK President 1300 PALM BAY RD NE SUITE 4, PALM BAY, FL, 329054019

Director

Name Role Address
KROENING, JACK Director 1300 PALM BAY RD NE SUITE 4, PALM BAY, FL, 329054019
DETTMER DALE A Director 304 SOUTH HARBOR CITY BLVD SUITE 201, MELBOURNE, FL, 32901
SULLIVAN W. J. Director 15 BUMELIA COURT, HOMOSASSA, FL, 34446
DICK JEFF Director 2288 HAMLET DRIVE, MELBOURNE, FL, 32934

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G10000117517 NORTH MELBOURNE DIALYSIS EXPIRED 2010-12-22 2015-12-31 No data 14 SUNTREE PLACE, SUITE 102, MELBOURNE, FL, 32940

Events

Event Type Filed Date Value Description
MERGER 2014-07-01 No data CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS 726583. MERGER NUMBER 900000141979

Related by officers

DETTMER DALE A

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DICK JEFF

SUNTREE DIALYSIS, INC.

DETTMER, DALE A.

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Related by address

No related companies by address

Date of last update: 03 Jan 2025

Sources: Florida Department of State

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