| Entity Name: | BONISTER DIALYSIS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Dec 2015 (9 years ago) |
| Document Number: | M15000010313 |
| FEI/EIN Number | 81-1077388 |
| Mail Address: | 601 Hawaii Street, El Segundo, CA, 90245, US |
| Address: | 2000 16th Street, Denver, CO, 80202, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235607144 | 2018-11-08 | 2024-06-25 | 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US | 5947 20TH ST, VERO BEACH, FL, 329664676, US | |||||||||||||||||||||
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| Phone | +1 772-770-0331 |
| Fax | 7727700336 |
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 | 104083800 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| TOTAL RENAL CARE, INC. | Auth | No data |
| Vero Dialysis Investments, LLC | Auth | 2000 16th Street, Denver, CO, 80202 |
| Caldwell Samantha A | Auth | 2000 16th Street, Denver, CO, 80202 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000122236 | SANDY SHORES DIALYSIS | ACTIVE | 2018-11-14 | 2028-12-31 | No data | 5947 20TH STREET, ATTN: JLD/SECGOVFIN., VERO BEACH, FL, 32966 |
| G16000050110 | OSLO DIALYSIS | ACTIVE | 2016-05-18 | 2026-12-31 | No data | 100 S US HIGHWAY, 1 ATTN: JLD/SECGOVFIN., VERO BEACH, FL, 32962 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-14 | 2000 16th Street, JLD/SecGovFin, Denver, CO 80202 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-14 | 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 | 2019-04-15 |
| ANNUAL REPORT | 2018-04-13 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-04-19 |
| Foreign Limited | 2015-12-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
