| Entity Name: | NORTHWEST JACKSONVILLE DIALYSIS CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Feb 2008 (17 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 17 May 2022 (3 years ago) |
| Document Number: | M08000000947 |
| FEI/EIN Number | 26-1983634 |
| Address: | 500 Cummings Center, Suite 6550, Beverly, MA, 01915, US |
| Mail Address: | 1725 Oakhurst Ave, Suite 100, Jacksonville, FL, 32208, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619120698 | 2008-11-04 | 2023-01-11 | 1725 OAKHURST AVENUE, SUITE 100, JACKSONVILLE, FL, 322083282, US | 1725 OAKHURST AVENUE, SUITE 100, JACKSONVILLE, FL, 322083282, US | |||||||||||||||||||||
|
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| Phone | +1 904-766-2279 |
| Fax | 9049247568 |
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 | 000987500 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Attmore George | Manager | 500 Cummings Center, Beverly, MA, 01915 |
| Name | Role | Address |
|---|---|---|
| Baker III M.D. James D. | Member | 500 Cummings Center, Beverly, MA, 01915 |
| Smart Jr. M.D. James B. | Member | 500 Cummings Center, Beverly, MA, 01915 |
| Brumback M.D. Michael B. | Member | 500 Cummings Center, Beverly, MA, 01915 |
| Shapiro M.D. Craig | Member | 500 Cummings Center, Beverly, MA, 01915 |
| AMERICAN RENAL ASSOCIATES LLC | Member | No data |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000124189 | ARA NORTH JACKSONVILLE | ACTIVE | 2016-11-17 | 2026-12-31 | No data | 500 CUMMINGS CENTER, SUITE 6550, BEVERLY, MA, 01915 |
| G08351900019 | NORTH JACKSONVILLE DIALYSIS CENTER | ACTIVE | 2008-12-16 | 2028-12-31 | No data | 500 CUMMINGS CENTER SUITE 6550, BEVERLY, MA, 01915 |
| G08234900019 | ARA NORTH JACKSONVILLE | EXPIRED | 2008-08-21 | 2013-12-31 | No data | 66 CHERRY HILL DRIVE, 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 | 2025-01-24 |
| ANNUAL REPORT | 2024-03-28 |
| ANNUAL REPORT | 2023-02-20 |
| CORLCRACHG | 2022-05-17 |
| ANNUAL REPORT | 2022-03-30 |
| 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 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
