HOMESTEAD ARTIFICIAL KIDNEY CENTER, INC.

Company Details

Entity Name:	HOMESTEAD ARTIFICIAL KIDNEY CENTER, INC.
Jurisdiction:	FLORIDA
Filing Type:	Domestic Profit
Status:	Active
Date Filed:	13 Jan 1983 (42 years ago)
Document Number:	G22356
FEI/EIN Number	59-2263441
Address:	920 Winter St., Waltham, MA, 02451, US
Mail Address:	920 Winter St., Waltham, MA, 02451, US
Place of Formation:	FLORIDA

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1811009665

2006-08-31

2023-10-13

99 NE 8TH ST, HOMESTEAD, FL, 330304605, US

99 NE 8TH ST, HOMESTEAD, FL, 330304605, US

Contacts

Phone	+1 305-245-0241
Fax	3052461259

Authorized person

Name	BARRY L. BLANTON
Role	VICE PRESIDENT
Phone	7816999000

Taxonomy

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

Other Provider Identifiers

Issuer	MEDICAID
Number	200558100
State	FL

Agent

Name	Role
C T CORPORATION SYSTEM	Agent

Assi

Name	Role	Address
Mello Bryan	Assi	920 Winter St., Waltham, MA, 02451

Vice President

Name	Role	Address
Bucci Brad	Vice President	920 Winter St., Waltham, MA, 02451
Valle Ryan	Vice President	920 Winter St., Waltham, MA, 02451

Director

Name	Role	Address
Valle William	Director	920 Winter St., Waltham, MA, 02451

Chief Executive Officer

Name	Role	Address
Valle William J	Chief Executive Officer	920 Winter St., Waltham, MA, 02451

Chief Financial Officer

Name	Role	Address
Braun Dennis	Chief Financial Officer	920 Winter St., Waltham, MA, 02451

Fictitious Names

Registration Number	Fictitious Name	Status	Filed Date	Expiration Date	Cancellation Date	Mailing Address
G22000076868	BMA OF HOMESTEAD	ACTIVE	2022-06-27	2027-12-31	No data	99 NE 8TH ST, HOMESTEAD, FL, 33030

Events

Event Type	Filed Date	Value	Description
REINSTATEMENT	1985-06-12	No data	No data
INVOLUNTARILY DISSOLVED	1984-11-21	No data	No data

Date of last update: 02 Feb 2025

Sources: Florida Department of State