| Entity Name: | ARA-ORANGE PARK LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Oct 2001 (23 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 17 May 2022 (3 years ago) |
| Document Number: | L01000017845 |
| FEI/EIN Number | 04-3579269 |
| Address: | 500 Cummings Center, Beverly, MA, 01915, US |
| Mail Address: | 2141 Loch Rane Blvd, Orange Park, FL, 32073, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033135306 | 2006-07-13 | 2023-01-10 | 2141 LOCH RANE BLVD STE 112&115, ORANGE PARK, FL, 320735723, US | 2141 LOCH RANE BLVD STE 112&115, ORANGE PARK, FL, 320735723, US | |||||||||||||||||||||
|
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| Phone | +1 904-272-7331 |
| Fax | 9042729425 |
Authorized person
| Name | MRS. SARA ANNE BRADY |
| Role | CHIEF NURSING OFFICER |
| Phone | 2083717878 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 200582400 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Attmore George | Manager | 500 Cummings Center, Beverly, MA, 01915 |
| Mendez Nick | Manager | 500 Cummings Center, Beverly, MA, 01915 |
| Kotihal Ramesh M.D. | Manager | 500 Cummings Center, Beverly, MA, 01915 |
| Baker III James D | Manager | 500 Cummings Center, Beverly, MA, 01915 |
| Kamal Syed T | Manager | 500 Cummings Center, Beverly, MA, 01915 |
| Name | Role | Address |
|---|---|---|
| Northeast Florida Dialysis Center Partners | Member | 500 Cummings Center, Beverly, MA, 01915 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000116059 | NORTHEAST FLORIDA DIALYSIS CENTER | ACTIVE | 2011-12-01 | 2026-12-31 | No data | 2141 LOCH RANE BLVD, SUITE 115, ORANGE PARK, FL, 32073 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-22 | 500 Cummings Center, Suite 6550, Beverly, MA 01915 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-22 | 500 Cummings Center, Suite 6550, Beverly, MA 01915 | No data |
| LC STMNT OF RA/RO CHG | 2022-05-17 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-05-17 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-05-17 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-28 |
| ANNUAL REPORT | 2024-03-27 |
| ANNUAL REPORT | 2023-02-22 |
| CORLCRACHG | 2022-05-17 |
| ANNUAL REPORT | 2022-03-29 |
| ANNUAL REPORT | 2021-04-17 |
| ANNUAL REPORT | 2020-06-03 |
| ANNUAL REPORT | 2019-03-19 |
| ANNUAL REPORT | 2018-04-06 |
| ANNUAL REPORT | 2017-04-17 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
