| Entity Name: | DVA RENAL HEALTHCARE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Profit |
| Status: | Active |
| Date Filed: | 21 Mar 2000 (25 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 24 Oct 2005 (19 years ago) |
| Document Number: | F00000001720 |
| FEI/EIN Number | 621323090 |
| Mail Address: | 601 Hawaii Street, El Segundo, CA, 90245, US |
| Address: | 2000 16th Street, Denver, CO, 80202, US |
| Place of Formation: | TENNESSEE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043277015 | 2006-04-26 | 2024-03-14 | 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US | 3363 NW 167TH ST, MIAMI GARDENS, FL, 330564254, US | |||||||||||||||||||||||||
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| Phone | +1 615-320-4593 |
| Fax | 8002935872 |
| Phone | +1 305-627-9311 |
| Fax | 3056289389 |
Authorized person
| Name | SAMUEL T WEY |
| Role | VP LICENSURE & CERTIFICATION |
| Phone | 6153416641 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 891993300 |
| State | FL |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5WXQ4 | Cancelled Without Replacement | Non-Manufacturer | 2010-03-04 | 2020-11-16 | 2020-11-16 | No data | |||||||||||||
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| POC | BOB BADAL |
| Phone | +1 310-536-2575 |
| Address | 661 9TH ST N, NAPLES, FL, 34102 8132, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | Information not Available |
|---|
| List of Offerors (0) | Information not Available |
|---|
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Caldwell Samantha A | Auth | 2000 16th Street, Denver, CO, 80202 |
| Name | Role | Address |
|---|---|---|
| Staffieri Michael D | Director | 2000 16th Street, Denver, CO, 80202 |
| Name | Role | Address |
|---|---|---|
| Berry Christopher M | Treasurer | 2000 16th Street, Denver, CO, 80202 |
| Name | Role | Address |
|---|---|---|
| Berberich Stephanie N | Secretary | 2000 16th Street, Denver, CO, 80202 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000033342 | MELBOURNE DIALYSIS | ACTIVE | 2021-03-10 | 2026-12-31 | No data | 4175 W NEW HAVEN AVE, STE 15, ATTN: JLD/SECGOVFIN, MELBOUEN, FL, 32904 |
| G17000138751 | SOUTH BROWARD ACUTES | ACTIVE | 2017-12-19 | 2027-12-31 | No data | 1299 E COMMERCIAL BLVD, SUITE 202, ATTN: JLD/SECGOVFIN., OAKLAND PARK, FL, 33334--480 |
| G17000117755 | FLORIDA MEDICAL ACUTES | EXPIRED | 2017-10-25 | 2022-12-31 | No data | 1299 E. COMMERCIAL BLVD, SUITE 202, OAKLAND PARK, FL, 33334 |
| G17000115950 | FLORIDA ACUTES | ACTIVE | 2017-10-20 | 2027-12-31 | No data | 1299 E COMMERCIAL BLVD, STE 202, ATTN: JLD/SECGOVFIN., OAKLAND PARK, FL, 33334 |
| G15000112506 | ORLANDO NORTH DIALYSIS | ACTIVE | 2015-11-04 | 2025-12-31 | No data | 601 HAWAII STREET, ATTN: JLD/SECGOVFIN, EL SEGUNDO, CA, 90245 |
| G15000112512 | ORLANDO SOUTHWEST DIALYSIS | ACTIVE | 2015-11-04 | 2025-12-31 | No data | 601 HAWAII STREET, ATTN: JLD/SECGOVFIN, EL SEGUNDO, CA, 90245 |
| G13000108877 | LAKELAND SOUTH DIALYSIS | ACTIVE | 2013-11-05 | 2028-12-31 | No data | 4774 S. FLORIDA AVENUE, ATTN: JLD/SECGOVFIN., LAKELAND, FL, 33813 |
| G13000076288 | LAKELAND SOUTH DIALYSIS | EXPIRED | 2013-07-31 | 2018-12-31 | No data | 4730 S. FLORIDA AVENUE, UNITE 11, LAKELAND, FL, 33813 |
| G13000069144 | MIAMI CAMPUS DIALYSIS | ACTIVE | 2013-07-09 | 2028-12-31 | No data | 1951 NW 7TH AVENUE, SUITE 500, MIAMI, FL, 33136 |
| G12000004021 | MIAMI GARDENS DIALYSIS | ACTIVE | 2012-01-11 | 2027-12-31 | No data | 3363 NW 167TH ST., ATTN: JLD/SECGOVFIN., MIAMI GARDENS, FL, 33056 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-14 | 2000 16th Street, JLD/SecGovFin, Denver, CO 80202 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-14 | 2000 16th Street, JLD/SecGovFin, Denver, CO 80202 | No data |
| NAME CHANGE AMENDMENT | 2005-10-24 | DVA RENAL HEALTHCARE, INC. | No data |
| MERGER | 2005-01-24 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 100000051831 |
| AMENDMENT | 2004-12-14 | No data | MERGER MERGING GAMBRO HEALTHCARE OF EAST ORLANDO, LLP FILED IN ERROR - UPDATED AS AMENDMENT 3/3/05 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-04-23 |
| ANNUAL REPORT | 2021-04-27 |
| ANNUAL REPORT | 2020-05-01 |
| ANNUAL REPORT | 2019-04-15 |
| ANNUAL REPORT | 2018-04-16 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-04-19 |
| ANNUAL REPORT | 2015-04-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
