| Entity Name: | CORVA CLINICS - MIAMI SHORES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 24 Oct 2012 (12 years ago) |
| Date of dissolution: | 25 Sep 2015 (9 years ago) |
| Last Event: | REVOKED FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (9 years ago) |
| Document Number: | M12000005997 |
| FEI/EIN Number | 352452736 |
| Address: | 5613 DTC PARKWAY, STE. 800, GREENWOOD VILLAGE, CO, 80111 |
| Mail Address: | 5613 DTC PARKWAY, STE. 800, GREENWOOD VILLAGE, CO, 80111 |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033467816 | 2012-08-27 | 2012-08-27 | 5613 DTC PKWY, SUITE 800, GREENWOOD VILLAGE, CO, 801113028, US | 9999 NE 2ND AVE, MIAMI SHORES, FL, 331382352, US | |||||||||||||||||||||
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| Phone | +1 720-402-3881 |
| Phone | +1 305-756-4400 |
Authorized person
| Name | JERRY SIMONSEN |
| Role | CEO |
| Phone | 7204023881 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PROVIDER NUMBER |
| Number | 102800 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| SIMONSEN JERRY | Manager | 5613 DTC PARKWAY, STE. 800, GREENWOOD VILLAGE, CO, 80111 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000104865 | CORVA KIDNEY CENTER - MIAMI SHORES | EXPIRED | 2012-10-29 | 2017-12-31 | No data | 5613 DTC PARKWAY, STE. 800, GREENWOOD VILLAGE, CO, 80111 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REVOKED FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| REINSTATEMENT | 2013-10-16 | No data | No data |
| REVOKED FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-04-18 |
| REINSTATEMENT | 2013-10-16 |
| Foreign Limited | 2012-10-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
