| Entity Name: | PALMETTO DIALYSIS CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Aug 2007 (17 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 17 May 2022 (3 years ago) |
| Document Number: | M07000005129 |
| FEI/EIN Number | 26-0722021 |
| Address: | 500 Cummings Center, Suite 6550, Beverly, MA, 01915, US |
| Mail Address: | 3820 US 301 N, Ellenton, FL, 34222, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386836815 | 2007-08-17 | 2023-01-10 | 3820 US HIGHWAY 301 N, ELLENTON, FL, 342222331, US | 3820 US HIGHWAY 301 N, ELLENTON, FL, 342222331, US | |||||||||||||||||||||
|
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| Phone | +1 941-722-3733 |
| Fax | 9417223766 |
Authorized person
| Name | 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 | 006344100 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Bala Jennifer CM.D. | Member | 500 Cummings Center, Beverly, MA, 01915 |
| AMERICAN RENAL ASSOCIATES LLC | Member | No data |
| Name | Role | Address |
|---|---|---|
| Kamal Syed T | Manager | 500 Cummings Center, Beverly, MA, 01915 |
| Palomino Celestino M.D. | Manager | 500 Cummings Center, Beverly, MA, 01915 |
| Mendez Nick M.D. | Manager | 1550 W. MCEWEN DR.,, FRANKLIN, TN, 37067 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000008057 | PLANTATION DIALYSIS C/O AMERICAN RENAL ASSOCIATES | ACTIVE | 2016-01-22 | 2026-12-31 | No data | 500 CUMMINGS CENTER, SUITE 6550, BEVERLY, MA, 01915 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-02-20 | 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 |
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-17 | 500 Cummings Center, Suite 6550, Beverly, MA 01915 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-09 |
| ANNUAL REPORT | 2024-02-23 |
| ANNUAL REPORT | 2023-02-20 |
| CORLCRACHG | 2022-05-17 |
| ANNUAL REPORT | 2022-03-29 |
| ANNUAL REPORT | 2021-04-17 |
| ANNUAL REPORT | 2020-06-04 |
| ANNUAL REPORT | 2019-03-21 |
| ANNUAL REPORT | 2018-04-06 |
| ANNUAL REPORT | 2017-04-18 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
