| Entity Name: | CRAVILLE DIALYSIS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Jul 2022 (3 years ago) |
| Document Number: | M22000010412 |
| FEI/EIN Number | 88-3132736 |
| Address: | 2000 16TH STREET, DENVER, CO, 80202, US |
| Mail Address: | 601 HAWAII STREET, EL SEGUNDO, CA, 90245, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295469252 | 2022-07-14 | 2024-09-16 | 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US | 1407 SE GOLDTREE DR STE A, PORT ST LUCIE, FL, 349527562, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 772-335-8672 |
| Fax | 7723354489 |
Authorized person
| Name | SAMUEL T. WEY |
| Role | VP, LICENSURE & CERTIFICATION |
| Phone | 6153416641 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| Is Primary | Yes |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| TOTAL RENAL CARE, INC. | Auth | No data |
| Caldwell Samantha A | Auth | 2000 16TH STREET, DENVER, CO, 80202 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000083733 | TREASURE COAST DIALYSIS | ACTIVE | 2022-07-14 | 2027-12-31 | No data | 1407 SOUTHEAST GOLDTREE DRIVE, SUITE A, ATTN: JLD/SECGOVFIN., PORT ST. LUCIE, FL, 34952 |
| 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 |
| Foreign Limited | 2022-07-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
