| Entity Name: | PEDIATRICS AT RIVER'S EDGE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 05 Sep 2014 (10 years ago) |
| Document Number: | P14000073760 |
| FEI/EIN Number | 47-1773698 |
| Address: | 9948 GROVE DRIVE, NEW PORT RICHEY, FL, 34654, US |
| Mail Address: | 9948 GROVE DRIVE, NEW PORT RICHEY, FL, 34654, US |
| ZIP code: | 34654 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003217183 | 2014-09-09 | 2017-11-08 | 6352 RIVER RD, NEW PORT RICHEY, FL, 346522241, US | 6352 RIVER RD, NEW PORT RICHEY, FL, 346522241, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 727-844-3551 |
| Fax | 7278470427 |
Authorized person
| Name | DR. ALDO C DONDERO |
| Role | PRESIDENT |
| Phone | 7278443551 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
| Taxonomy Code | 363LP0200X - Pediatric Nurse Practitioner |
| License Number | 3078370 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363LP0200X - Pediatric Nurse Practitioner |
| License Number | 1881067460 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 268389000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DONDERO ALDO C | Agent | 9948 GROVE DRIVE, NEW PORT RICHEY, FL, 34654 |
| Name | Role | Address |
|---|---|---|
| DONDERO ALDO CDR. | President | 9948 GROVE DRIVE, NEW PORT RICHEY, FL, 34654 |
| Name | Role | Address |
|---|---|---|
| Dondero Eleanor V | Vice President | 9948 GROVE DRIVE, NEW PORT RICHEY, FL, 34654 |
| Name | Role | Address |
|---|---|---|
| Dondero Elijah | Asst | 9948 GROVE DRIVE, New Port Richey, FL, 34654 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-17 | 9948 GROVE DRIVE, NEW PORT RICHEY, FL 34654 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-17 | 9948 GROVE DRIVE, NEW PORT RICHEY, FL 34654 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-17 | 9948 GROVE DRIVE, NEW PORT RICHEY, FL 34654 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-09-30 | DONDERO, ALDO C | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-17 |
| ANNUAL REPORT | 2023-03-30 |
| ANNUAL REPORT | 2022-04-12 |
| ANNUAL REPORT | 2021-02-11 |
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-04-23 |
| ANNUAL REPORT | 2018-04-02 |
| ANNUAL REPORT | 2017-01-26 |
| Off/Dir Resignation | 2016-09-30 |
| Reg. Agent Change | 2016-09-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
