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 |
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 | |||||||||||||||||||||
|
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 |
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 | - |
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 |
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 | 2019-04-15 |
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