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GAVIOTA DIALYSIS, LLC - Florida Company Profile

Company Details

Entity Name: GAVIOTA 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: 08 May 2014 (11 years ago)
Document Number: M14000003165
FEI/EIN Number 275405760

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

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1104217918 2015-02-16 2024-08-09 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US 1200 DELTONA BLVD, STE 26, DELTONA, FL, 327256389, US

Contacts

Phone +1 386-574-0225
Fax 3865746460

Authorized person

Name SAMUEL WEY
Role VP, 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 015058200
State FL

Key Officers & Management

Name Role Address
TOTAL RENAL CARE, INC. Auth -
MODEPE MANAGEMENT, LLC Auth -
Caldwell Samantha A Auth 2000 16th Street, Denver, CO, 80202
CORPORATION SERVICE COMPANY Agent -

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G22000117933 DELTONA DIALYSIS ACTIVE 2022-09-19 2027-12-31 - 1200 DELTONA BLVD., STE 26, ATTN: JLD/SECGOVFIN, DELTONA, FL, 32725
G22000112943 DELTONA DIALYSIS ACTIVE 2022-09-09 2027-12-31 - 1200 DELTON BOULEVARD, SUITE 26, DELTONA, FL, 32725
G15000030499 DELTONA DIALYSIS EXPIRED 2015-03-24 2020-12-31 - 1200 DELTONA BOULEVARD, SUITE 26, DELTONA, FL, 32725

Events

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 -

Documents

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 2019-04-15
ANNUAL REPORT 2018-04-16
ANNUAL REPORT 2017-04-19
ANNUAL REPORT 2016-04-19
ANNUAL REPORT 2015-04-28

Date of last update: 02 Mar 2025

Sources: Florida Department of State