| Entity Name: | LOURDES DIALYSIS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Mar 2013 (12 years ago) |
| Document Number: | M13000001520 |
| FEI/EIN Number | 46-2431255 |
| 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 | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093294548 | 2018-08-07 | 2024-03-05 | 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US | 1350 N HANCOCK RD, CLERMONT, FL, 347115952, US | |||||||||||||||||||||||||||
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| Phone | +1 615-320-4593 |
| Fax | 8002935872 |
| Phone | +1 352-394-0072 |
| Fax | 3522410433 |
Authorized person
| Name | SAMUEL T WEY |
| Role | VP, 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 | 102839700 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| TOTAL RENAL CARE, INC. | Auth | No data |
| RENAL VENTURES OF CENTRAL FLORIDA, 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 |
|---|---|---|---|---|---|---|
| G24000103598 | ALAFAYA DIALYSIS | ACTIVE | 2024-08-29 | 2029-12-31 | No data | 12001 SCIENCE DR, STE 110, ORLANDO, FL, 32826 |
| G18000020074 | CLARCONA DIALYSIS | ACTIVE | 2018-02-06 | 2028-12-31 | No data | 8259 CLARCONA OCOEE RD, ATTN: JLD/SECGOVFIN., APOPKA, FL, 32818 |
| G18000020083 | CLERMONT DIALYSIS | ACTIVE | 2018-02-06 | 2028-12-31 | No data | 1350 N. HANCOCK RD, ATTN: JLD/SECGOVFIN., CLERMONT, FL, 34711 |
| G17000021637 | ALAFAYA DIALYSIS | EXPIRED | 2017-02-28 | 2022-12-31 | No data | 601 HAWAII STREET, ATTN: JLD/SECGOVFIN., EL SEGUNDO, CA, 90245 |
| G14000034542 | LAKE MARY DIALYSIS | ACTIVE | 2014-04-07 | 2029-12-31 | No data | 39 SKYLINE DRIVE, SUITE 1001, LAKE MARY, FL, 32746 |
| G13000114488 | OVIEDO DIALYSIS | ACTIVE | 2013-11-21 | 2028-12-31 | No data | 7560 RED BUD LAKE ROAD, SUITE 1048, OVIEDO, FL, 32765 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-19 | 2000 16th Street, JLD/SecGovFin., Denver, CO 80202 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-19 | 2000 16th Street, JLD/SecGovFin., Denver, CO 80202 | No data |
| 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: 01 Feb 2025
Sources: Florida Department of State
