| Entity Name: | RENAL LIFE LINK, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Profit |
| Status: | Active |
| Date Filed: | 06 Dec 2004 (20 years ago) |
| Document Number: | F04000006864 |
| FEI/EIN Number | 201649898 |
| Address: | 2000 16th Street, JLD/SecGovFin, Denver, CO, 80202, US |
| Mail Address: | 601 Hawaii Street, JLD/SecGovFin, El Segundo, CA, 90245, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669438495 | 2006-04-21 | 2024-10-01 | 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US | 45597 HIGHWAY 27 RIDGEVIEW PLAZA, DAVENPORT, FL, 338974519, US | |||||||||||||||||||||
|
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| Phone | +1 863-419-7408 |
| Fax | 8634209165 |
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 | 890850800 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Staffieri Michael D | Director | 2000 16th Street, Denver, CO, 80202 |
| Name | Role | Address |
|---|---|---|
| Caldwell Samantha A | Auth | 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 |
|---|---|---|---|---|---|---|
| G15000112495 | EMBASSY LAKES ARTIFICIAL KIDNEY CENTER | ACTIVE | 2015-11-04 | 2025-12-31 | No data | 601 HAWAII STREET, ATTN: JLD/SECGOVFIN, EL SEGUNDO, CA, 90245 |
| G04343900011 | DAVENPORT DIALYSIS | ACTIVE | 2004-12-08 | 2029-12-31 | No data | 45597 HIGHWAY 27, ATTN: JLD/SECGOVFIN., DAVENPORT, FL, 33897 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-20 | 2000 16th Street, JLD/SecGovFin, Denver, CO 80202 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-20 | 2000 16th Street, JLD/SecGovFin, Denver, CO 80202 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-08-22 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-08-22 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-20 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-04-23 |
| ANNUAL REPORT | 2021-04-21 |
| ANNUAL REPORT | 2020-04-20 |
| ANNUAL REPORT | 2019-04-16 |
| ANNUAL REPORT | 2018-04-16 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-04-27 |
| ANNUAL REPORT | 2015-04-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
