| Entity Name: | CHALLIS 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: | 27 Jun 2017 (8 years ago) |
| Document Number: | M17000005438 |
| FEI/EIN Number |
82-2007334
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 | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700398427 | 2017-11-03 | 2023-10-24 | 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US | 10725 WILES RD, CORAL SPRINGS, FL, 330762014, US | |||||||||||||||||||||||||||
|
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| Phone | +1 615-320-4593 |
| Fax | 8002935872 |
| Phone | +1 954-796-9925 |
| Fax | 9547967360 |
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 | 101433300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TOTAL RENAL CARE, INC. | Auth | - |
| CORAL SPRINGS RENAL VENTURES 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 |
|---|---|---|---|---|---|---|
| G25000026333 | BROOKSIDE DIALYSIS | ACTIVE | 2025-02-21 | 2030-12-31 | - | 10725 WILES RD, ATTN: JLD/SECGOVFIN., CORAL SPRINGS, FL, 33076 |
| 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 | 2024-04-19 |
| 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 |
| Foreign Limited | 2017-06-27 |
Date of last update: 03 Mar 2025
Sources: Florida Department of State
