| Entity Name: | FLAMINGO PARK KIDNEY CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 28 May 1993 (32 years ago) |
| Last Event: | CORPORATE MERGER |
| Event Date Filed: | 31 Dec 1996 (28 years ago) |
| Document Number: | P93000038433 |
| FEI/EIN Number | 65-0431823 |
| Address: | 2000 16th Street, JLD/SecGovFin, Denver, CO 80202 |
| Mail Address: | 601 Hawaii Street, JLD/SecGovFin, El Segundo, CA 90245 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780651802 | 2006-03-07 | 2021-12-14 | 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US | 3280 PONCE DE LEON BLVD, CORAL GABLES, FL, 331347252, US | |||||||||||||||||||||||||
|
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| Phone | +1 615-320-4593 |
| Fax | 8002935872 |
| Phone | +1 305-448-9888 |
| Fax | 3054454984 |
Authorized person
| Name | JOHN D WINSTEL |
| Role | CHIEF ACCOUNTING OFFICER |
| Phone | 2537334501 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 212284701 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Staffieri, Michael D. | Director | 2000 16th Street, JLD/SecGovFin Denver, CO 80202 |
| Name | Role | Address |
|---|---|---|
| Staffieri, Michael D. | President | 2000 16th Street, JLD/SecGovFin Denver, CO 80202 |
| Name | Role | Address |
|---|---|---|
| Caldwell, Samantha A. | Authorized Person | 2000 16th Street, JLD/SecGovFin Denver, CO 80202 |
| Name | Role | Address |
|---|---|---|
| Berry, Christopher M. | Treasurer | 2000 16th Street, JLD/SecGovFin Denver, CO 80202 |
| Name | Role | Address |
|---|---|---|
| Berberich, Stephanie N. | Secretary | 2000 16th Street, JLD/SecGovFin Denver, CO 80202 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000105932 | CORAL GABLES KIDNEY CENTER | ACTIVE | 2015-10-16 | 2025-12-31 | No data | 601 HAWAII STREET, EL SEGUNDO, CA, 90245 |
| G15000100829 | FLAMINGO PARK KIDNEY CENTER | EXPIRED | 2015-10-01 | 2020-12-31 | No data | 601 HAWAII STREET, EL SEGUNDO, CA, 90245 |
| G15000100887 | INTERAMERICAN DIALYSIS CENTER | ACTIVE | 2015-10-01 | 2025-12-31 | No data | JLD/SECGOVFIN, 601 HAWAII STREET, EL SEGUNDO, CA, 90245 |
| G09000121478 | INTERAMERICAN DIALYSIS CENTER | EXPIRED | 2009-06-12 | 2014-12-31 | No data | 7815 CORAL WAY, SUITE 115, MIAMI, FL, 33155 |
| G09000100564 | CORAL GABLES KIDNEY CENTER | EXPIRED | 2009-04-23 | 2014-12-31 | No data | 3280 PONCE DE LEON BLVD., CORAL GABLES, FL, 33134 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-19 | 2000 16th Street, JLD/SecGovFin, Denver, CO 80202 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-19 | 2000 16th Street, JLD/SecGovFin, Denver, CO 80202 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-08-22 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-08-22 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| CORPORATE MERGER | 1996-12-31 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. CORPORATE MERGER NUMBER 100000012231 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-04-23 |
| ANNUAL REPORT | 2021-04-20 |
| ANNUAL REPORT | 2020-04-20 |
| ANNUAL REPORT | 2019-04-15 |
| ANNUAL REPORT | 2018-04-16 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-04-20 |
| ANNUAL REPORT | 2015-04-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
