| Entity Name: | GOLDTREE KIDNEY CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Oct 2007 (17 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 17 May 2022 (3 years ago) |
| Document Number: | M07000006276 |
| FEI/EIN Number | 26-1225415 |
| Address: | 500 Cummings Center, Suite 6550, Beverly, MA, 01915, US |
| Mail Address: | 1407-A Goldtree Drive, Port St. Lucie, FL, 34952, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346439387 | 2007-10-16 | 2022-08-18 | 1407 SE GOLDTREE DR STE A, PORT ST LUCIE, FL, 349527562, US | 1407 SE GOLDTREE DR STE A, PORT ST LUCIE, FL, 349527562, US | |||||||||||||||||||||
|
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| Phone | +1 772-335-8677 |
| Fax | 7723354489 |
Authorized person
| Name | KEISHA DENISE GREENE |
| Role | VP OF CLINICAL & REGULATORY |
| Phone | 9785223905 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000100700 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Mendez Nick | Manager | 4985 Heather Point, Birmingham, AL, 35242 |
| Flores Maria T | Manager | 1801 S. 23rd Street, Fort Pierce, FL, 34950 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-04-29 | 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 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-29 | 500 Cummings Center, Suite 6550, Beverly, MA 01915 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-05 |
| ANNUAL REPORT | 2023-04-29 |
| CORLCRACHG | 2022-05-17 |
| ANNUAL REPORT | 2022-03-29 |
| ANNUAL REPORT | 2021-04-17 |
| ANNUAL REPORT | 2020-06-04 |
| ANNUAL REPORT | 2019-03-20 |
| ANNUAL REPORT | 2018-04-06 |
| ANNUAL REPORT | 2017-04-17 |
| ANNUAL REPORT | 2016-04-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
