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INDIAN RIVER DIALYSIS CENTER, LLC - Florida Company Profile

Company Details

Entity Name: INDIAN RIVER DIALYSIS CENTER, LLC
Jurisdiction: FLORIDA
Filing Type: Foreign Limited Liability Co.
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 17 Oct 2006 (18 years ago)
Document Number: M06000005718
FEI/EIN Number 205739181

Federal Employer Identification (FEI) Number assigned by the IRS.

Address: 2000 16th Street, JLD/SecGovFin, Denver, CO, 80202, US
Mail Address: 601 Hawaii Street, JLD/SecGovFin, El Segundo, CA, 90245, US
Place of Formation: DELAWARE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1528113156 2007-01-24 2024-08-13 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US 2150 45TH ST UNIT 102, VERO BEACH, FL, 329676281, US

Contacts

Phone +1 772-567-2529
Fax 7725672587

Authorized person

Name SAMUEL T WEY
Role VP LICENSURE & CERTIFICATION
Phone 6153416641

Taxonomy

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

Other Provider Identifiers

Issuer MEDICAID
Number 892619100
State FL

Key Officers & Management

Name Role Address
RENAL TREATMENT CENTERS - SOUTHEAST, LP Auth -
PRI Dialysis, LLC Auth 2000 16th Street, Denver, CO, 80202
Caldwell Samantha A Auth 2000 16th Street, Denver, CO, 80202
CORPORATION SERVICE COMPANY Agent -

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G25000026494 INDIAN RIVER DIALYSIS CENTER ACTIVE 2025-02-21 2030-12-31 - 2150 45TH ST, ATTN: JLD/SECGOVFIN., VERO BEACH, FL, 32967

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-04-19 2000 16th Street, JLD/SecGovFin, Denver, CO 80202 -
CHANGE OF MAILING ADDRESS 2024-04-19 2000 16th Street, JLD/SecGovFin, Denver, CO 80202 -

Documents

Name Date
ANNUAL REPORT 2024-04-19
ANNUAL REPORT 2023-04-14
ANNUAL REPORT 2022-04-19
ANNUAL REPORT 2021-04-20
ANNUAL REPORT 2020-04-20
ANNUAL REPORT 2019-04-15
ANNUAL REPORT 2018-04-16
ANNUAL REPORT 2017-04-19
ANNUAL REPORT 2016-04-20
ANNUAL REPORT 2015-04-28

Date of last update: 03 Mar 2025

Sources: Florida Department of State