| Entity Name: | MAMMOTH DIALYSIS, 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: | 18 Oct 2011 (13 years ago) |
| Document Number: | M11000005216 |
| FEI/EIN Number |
453637644
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 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275810905 | 2011-11-09 | 2023-08-08 | 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US | 14358 N DALE MABRY HWY, TAMPA, FL, 336182018, US | |||||||||||||||||||||||||
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| Phone | +1 615-320-4593 |
| Fax | 8002935872 |
| Phone | +1 813-960-3751 |
| Fax | 8139617312 |
Authorized person
| Name | SAMUEL T WEY |
| Role | SR DIRECTOR,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 | 006349500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TOTAL RENAL CARE, INC. | Auth | - |
| Castillo Orlando MD | Auth | 2000 16th Street, Denver, CO, 80202 |
| Wong Lawrence MD | Auth | 2000 16th Street, Denver, CO, 80202 |
| Shah Jayesh | Auth | 2000 16th Street, Denver, CO, 80202 |
| Caldwell Samantha A | Auth | 2000 16th Street, Denver, CO, 80202 |
| CORPORATION SERVICE COMPANY | Agent | - |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000058677 | CARROLLWOOD DIALYSIS | ACTIVE | 2017-05-25 | 2027-12-31 | - | 14358 N. DALE MABRY HWY., ATTN: JLD/SECGOVFIN., TAMPA, FL, 33618 |
| G11000107489 | CARROLLWOOD DIALYSIS | EXPIRED | 2011-11-03 | 2016-12-31 | - | 14358 N. DALE MABRY HIGHWAY, TAMPA, FL, 33618 |
| 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 | - |
| 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 | 2019-04-16 |
| ANNUAL REPORT | 2018-04-16 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-04-21 |
| ANNUAL REPORT | 2015-04-28 |
Date of last update: 02 Mar 2025
Sources: Florida Department of State
