| 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 | |||||||||||||||||||||
|
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| 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
