| Entity Name: | DIALYSIS CENTER OF NORTH BREVARD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 22 May 2009 (16 years ago) |
| Date of dissolution: | 31 May 2024 (8 months ago) |
| Last Event: | PENDING REINSTATEMENT |
| Event Date Filed: | 31 May 2024 (8 months ago) |
| Document Number: | L09000050166 |
| FEI/EIN Number | 270337673 |
| Address: | 830 CENTURY MEDICAL DRIVE, SUITE C, TITUSVILLE, FL, 32796 |
| Mail Address: | 830 CENTURY MEDICAL DRIVE, SUITE C, TITUSVILLE, FL, 32796 |
| ZIP code: | 32796 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629207873 | 2009-07-09 | 2009-11-18 | 830 CENTURY MEDICAL DR, SUITE C, TITUSVILLE, FL, 327962149, US | 830 CENTURY MEDICAL DR, SUITE C, TITUSVILLE, FL, 327962149, US | |||||||||||||||||||||
|
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| Phone | +1 321-269-6270 |
Authorized person
| Name | DR. IMRAN RASHID |
| Role | MEDICAL DIRECTOR |
| Phone | 3212696270 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBSFL |
| Number | 06643A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BITTMAN MICHAEL J | Agent | 301 EAST PINE STREET, SUITE 1400, ORLANDO, FL, 32801 |
| Name | Role |
|---|---|
| NORTH BREVARD MEDICAL SUPPORT, INC. | Managing Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-05-31 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| REINSTATEMENT | 2010-10-18 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-10-18 | 830 CENTURY MEDICAL DRIVE, SUITE C, TITUSVILLE, FL 32796 | No data |
| CHANGE OF MAILING ADDRESS | 2010-10-18 | 830 CENTURY MEDICAL DRIVE, SUITE C, TITUSVILLE, FL 32796 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| Reg. Agent Resignation | 2024-06-28 |
| ANNUAL REPORT | 2012-06-12 |
| ANNUAL REPORT | 2011-02-16 |
| REINSTATEMENT | 2010-10-18 |
| Florida Limited Liability | 2009-05-22 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
