| Entity Name: | TRIVENO DIALYSIS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Jul 2022 (3 years ago) |
| Document Number: | M22000010410 |
| FEI/EIN Number | 88-3260126 |
| 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 | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447985213 | 2022-07-18 | 2024-01-29 | 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US | 3240 US HIGHWAY 441 S, OKEECHOBEE, FL, 349746239, US | |||||||||||||||||||||||||
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| Phone | +1 615-320-4593 |
| Fax | 8002935872 |
| Phone | +1 863-824-0225 |
| Fax | 8638240226 |
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 | 115951300 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role |
|---|---|
| TOTAL RENAL CARE, INC. | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000131655 | BIG LAKE DIALYSIS | ACTIVE | 2022-10-21 | 2027-12-31 | No data | ATTN JLD/SECGOVFIN, 3240 US HIGHWAY 441 S, OKEECHOBEE, FL, 34974 |
| G22000085231 | BIG LAKE KIDNEY CENTER | ACTIVE | 2022-07-18 | 2027-12-31 | No data | 3240 US HIGHWAY 441 S, JLD/SECGOVFIN., OKEECHOBEE, FL, 34974 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-30 | 2000 16th Street, JLD/SecGovFin., Denver, CO 80202 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-30 | 2000 16th Street, JLD/SecGovFin., Denver, CO 80202 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-15 |
| Foreign Limited | 2022-07-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
