| Entity Name: | CLEWISTON DIALYSIS CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Dec 2014 (10 years ago) |
| Document Number: | M14000008992 |
| FEI/EIN Number | 47-2480014 |
| Address: | 500 CUMMINGS CENTER, BEVERLY, MA, 01915, US |
| Mail Address: | 851 West Ventura Avenue, Clewiston, FL, 33440, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144628017 | 2014-12-09 | 2023-01-13 | 851 W VENTURA AVE, CLEWISTON, FL, 334403409, US | 851 W VENTURA AVE, CLEWISTON, FL, 334403409, US | |||||||||||||||||||||
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| Phone | +1 863-983-8855 |
| Fax | 8639835216 |
Authorized person
| Name | SARA ANNE BRADY |
| Role | CHIEF NURSING OFFICER |
| Phone | 2083717878 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 014649900 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Attmore George | Manager | 500 CUMMINGS CENTER, BEVERLY, MA, 01915 |
| Kamal Syed T | Manager | 500 CUMMINGS CENTER, BEVERLY, MA, 01915 |
| Abraham Mohan M.D. | Manager | 500 CUMMINGS CENTER, BEVERLY, MA, 01915 |
| Name | Role |
|---|---|
| AMERICAN RENAL ASSOCIATES LLC | Member |
| ABRAHAM FAMILY ENTERPRISES, LLC | Member |
| ASHESH, LLC | Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-21 | 500 CUMMINGS CENTER, Suite 6550, BEVERLY, MA 01915 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-21 | 500 CUMMINGS CENTER, Suite 6550, BEVERLY, MA 01915 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-05-17 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-05-17 | 1201 HAYS STREET, TALLAHASSEE, FL 32301 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-26 |
| ANNUAL REPORT | 2023-02-21 |
| Reg. Agent Change | 2022-05-17 |
| ANNUAL REPORT | 2022-03-30 |
| ANNUAL REPORT | 2021-04-17 |
| ANNUAL REPORT | 2020-06-04 |
| ANNUAL REPORT | 2019-03-20 |
| ANNUAL REPORT | 2018-04-10 |
| ANNUAL REPORT | 2017-04-17 |
| ANNUAL REPORT | 2016-04-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
