| Entity Name: | ALTERRA 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: | 06 Oct 2016 (8 years ago) |
| Document Number: | M16000007992 |
| FEI/EIN Number |
81-4078505
Federal Employer Identification (FEI) Number assigned by the IRS. |
| 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 | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568993947 | 2017-03-27 | 2024-08-12 | 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US | 3997 S NOVA RD, RIVERWOOD PLAZA, PORT ORANGE, FL, 321279296, US | |||||||||||||||||||||||
|
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| Phone | +1 386-761-7961 |
| Fax | 3867632150 |
Authorized person
| Name | SAMUEL T. WEY |
| Role | VP, LICENSURE & CERTIFICATION |
| Phone | 6153416641 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 10047330 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RENAL TREATMENT CENTERS - SOUTHEAST, LP | Auth | - |
| DAYTONA KIDNEY CONSULTANTS,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 |
|---|---|---|---|---|---|---|
| G24000103647 | PORT ORANGE DIALYSIS | ACTIVE | 2024-08-29 | 2029-12-31 | - | 3997 S NOVA RD, ATTN: JLD/SECGOVFIN., PORT ORANGE, FL, 32127 |
| G17000040914 | PORT ORANGE DIALYSIS | EXPIRED | 2017-04-14 | 2022-12-31 | - | 601 HAWAII STREET, ATTN: JLD/SECGOVFIN., EL SEGUNDO, CA, 90245 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-14 | 2000 16th Street, JLD/SecGovFin, Denver, CO 80202 | - |
| CHANGE OF MAILING ADDRESS | 2023-04-14 | 2000 16th Street, JLD/SecGovFin, Denver, CO 80202 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-18 |
| 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 |
| Foreign Limited | 2016-10-06 |
Date of last update: 01 Mar 2025
Sources: Florida Department of State
