| Entity Name: | SOUTH FLORIDA KIDNEY CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 30 Oct 2013 (11 years ago) |
| Last Event: | LC AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 18 Feb 2020 (5 years ago) |
| Document Number: | L13000155035 |
| FEI/EIN Number | 46-4037017 |
| Address: | 920 Winter St., Waltham, MA 02451 |
| Mail Address: | 920 Winter St., Waltham, MA 02451 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316367998 | 2014-04-22 | 2024-07-24 | 3854 SHERIDAN ST STE A, HOLLYWOOD, FL, 330213630, US | 3854 SHERIDAN ST STE A, HOLLYWOOD, FL, 330213630, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 954-966-3018 |
| Fax | 9549665249 |
Authorized person
| Name | RYAN VALLE |
| Role | PRESIDENT |
| Phone | 7816999362 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 012854700 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role |
|---|---|
| FRESENIUS MEDICAL CARE PRACTICE SERVICES, LLC | Memeber |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000103692 | COMPREHENSIVE KIDNEYCARE OF SOUTH FLORIDA | ACTIVE | 2023-09-01 | 2028-12-31 | No data | 920 WINTER STREET, WALTHAM, MA, 02451 |
| G17000024390 | COMPREHENSIVE KIDNEYCARE OF SOUTH FLORIDA | EXPIRED | 2017-03-07 | 2022-12-31 | No data | 4060 SHERIDAN STREET SUITE B, HOLLYWOOD, FL, 33021 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-30 | 920 Winter St., Waltham, MA 02451 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-30 | 920 Winter St., Waltham, MA 02451 | No data |
| LC AMENDMENT AND NAME CHANGE | 2020-02-18 | SOUTH FLORIDA KIDNEY CARE, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-09 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-03-30 |
| ANNUAL REPORT | 2021-05-01 |
| ANNUAL REPORT | 2020-06-01 |
| LC Amendment and Name Change | 2020-02-18 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-04-06 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-04-16 |
Date of last update: 22 Jan 2025
Sources: Florida Department of State
