| Entity Name: | PALISADES DIALYSIS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 09 Jan 2012 (13 years ago) |
| Document Number: | M12000000120 |
| FEI/EIN Number | 45-4197326 |
| 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 | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811428287 | 2017-03-27 | 2023-09-11 | 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US | 5200 NE 2ND AVE, MIAMI, FL, 331372706, US | |||||||||||||||||||||||||||
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| Phone | +1 615-320-4593 |
| Fax | 8002935872 |
| Phone | +1 305-751-8699 |
| Fax | 3057958000 |
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 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 101448500 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| TOTAL RENAL CARE, INC. | Auth | No data |
| MIAMI JEWISH HEALTH SYSTEMS, INC. | Auth | No data |
| PREMIER RENAL GROUP LLC | Auth | No data |
| Caldwell Samantha A | Auth | 2000 16th Street, Denver, CO, 80202 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000100859 | MIAMI JEWISH DIALYSIS | ACTIVE | 2024-08-23 | 2029-12-31 | No data | 5200 NE 2ND AVE, ATTN: SECGOVFIN., MIAMI, FL, 33137 |
| G17000040915 | MIAMI JEWISH DIALYSIS | EXPIRED | 2017-04-14 | 2022-12-31 | No data | 601 HAWAII STREET, ATTN: JLD/SECGOVFIN., EL SEGUNDO, CA, 90245 |
| G12000012950 | CAROL CITY DIALYSIS | EXPIRED | 2012-02-06 | 2017-12-31 | No data | 4400 W. HALLANDALE BEACH BLVD., PEMBROKE PINES, FL, 33023 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-20 | 2000 16th Street, JLD/SecGovFin, Denver, CO 80202 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-20 | 2000 16th Street, JLD/SecGovFin, Denver, CO 80202 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-20 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-04-19 |
| ANNUAL REPORT | 2021-04-21 |
| 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: 01 Feb 2025
Sources: Florida Department of State
