| Entity Name: | LIFELINE DIALYSIS CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 25 Jul 2008 (17 years ago) |
| Date of dissolution: | 25 Sep 2009 (15 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2009 (15 years ago) |
| Document Number: | L08000071767 |
| Address: | 3601 W COMMERCIAL BLVD, SUITE 35-36, FT LAUDERDALE, FL, 33309, US |
| Mail Address: | 3601 W COMMERCIAL BLVD, SUITE 35-36, FT LAUDERDALE, FL, 33309, US |
| ZIP code: | 33309 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740431089 | 2008-10-06 | 2008-10-06 | 3601 W COMMERCIAL BLVD, #35, FT LAUDERDALE, FL, 333093300, US | 3601 W COMMERCIAL BLVD, #35, FT LAUDERDALE, FL, 333093300, US | |||||||||||||||||||||
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| Phone | +1 954-676-5488 |
| Fax | 9546765560 |
Authorized person
| Name | MS. BETTY JEAN VERBAL |
| Role | ADMIN./CEO |
| Phone | 9546765488 |
Taxonomy
| Taxonomy Code | 332BD1200X - Dialysis Equipment & Supplies (DME) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PROVIDER NUMBER |
| Number | 1257170001 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VERBAL BETTY J | Agent | 3601 W COMMERCIAL BLVD, FT LAUDERDALE, FL, 33309 |
| Name | Role | Address |
|---|---|---|
| VERBAL BETTY J | Managing Member | 3601 W COMMERCIAL BLVD SUITE 35-36, FT LAUDERDALE, FL, 33309 |
| SANCHEZ-FORTIS ALFREDO | Managing Member | 3601 W COMMERCIAL BLVD SUITE 35-36, FT LAUDERDALE, FL, 33309 |
| POULSEN DONNA | Managing Member | 3601 W COMMERCIAL BLVD SUITE 35-36, FT LAUDERDALE, FL, 33309 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2008-07-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
