| Entity Name: | TOTAL RENAL LABORATORIES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 25 Oct 1993 (31 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 24 Jul 1998 (27 years ago) |
| Document Number: | P93000075674 |
| FEI/EIN Number | 59-3205549 |
| Mail Address: | 601 Hawaii Street, El Segundo, CA 90245 |
| Address: | 3000 DaVita Way, DeLand, FL 32724 |
| ZIP code: | 32724 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | TOTAL RENAL LABORATORIES, INC., KENTUCKY | 1055197 | KENTUCKY |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1245720820 | 2018-05-18 | 2024-08-28 | PO BOX 100244, ATLANTA, GA, 303840244, US | 3000 DAVITA WAY, DELAND, FL, 32724, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 386-626-5700 |
| Fax | 3866265638 |
Authorized person
| Name | KERI WAGNER |
| Role | VP - GENERAL MANAGER |
| Phone | 3866265700 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| License Number | 800005025 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0015880660004 |
| State | PA |
| Issuer | MEDICAID |
| Number | 0326359 |
| State | OH |
| Issuer | MEDICAID |
| Number | 081833728 |
| State | DC |
| Issuer | MEDICAID |
| Number | 100758080B |
| State | OK |
| Issuer | MEDICAID |
| Number | 1245720820 |
| State | ID |
| Issuer | MEDICAID |
| Number | 1245720820 |
| State | NC |
| Issuer | MEDICAID |
| Number | 1245720820 |
| State | CA |
| Issuer | MEDICAID |
| Number | 1245720820 |
| State | CO |
| Issuer | MEDICAID |
| Number | 3010008 |
| State | UT |
| Issuer | MEDICAID |
| Number | 3995045-01 |
| State | TX |
| Issuer | MEDICAID |
| Number | 04402709 |
| State | MS |
| Issuer | MEDICAID |
| Number | 101245100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 110148599A |
| State | MA |
| Issuer | MEDICAID |
| Number | 1245720820 |
| State | MN |
| Issuer | MEDICAID |
| Number | 1477612 |
| State | ND |
| Issuer | MEDICAID |
| Number | 228520 |
| State | AL |
| Issuer | MEDICAID |
| Number | 232372709 |
| State | AR |
| Issuer | MEDICAID |
| Number | 300022760 |
| State | IN |
| Issuer | MEDICAID |
| Number | 1245720820 |
| State | WV |
| Issuer | MEDICAID |
| Number | 2124491 |
| State | WA |
| Issuer | MEDICAID |
| Number | 283981402 |
| State | MD |
| Issuer | MEDICAID |
| Number | 3118922 |
| State | NH |
| Issuer | MEDICAID |
| Number | 500761736 |
| State | OR |
| Issuer | MEDICAID |
| Number | 0412083 |
| State | IA |
| Issuer | MEDICAID |
| Number | 1245720820 |
| State | WY |
| Issuer | MEDICAID |
| Number | 1245720820 |
| State | WI |
| Issuer | MEDICAID |
| Number | 0706493 |
| State | NJ |
| Issuer | MEDICAID |
| Number | 1245720820 |
| State | MI |
| Issuer | MEDICAID |
| Number | 1245720820 |
| State | CT |
| Issuer | MEDICAID |
| Number | 1245720820 |
| State | VA |
| Issuer | MEDICAID |
| Number | 38436361 |
| State | NM |
| Issuer | MEDICAID |
| Number | 7100581410 |
| State | KY |
| Issuer | MEDICAID |
| Number | L00677 |
| State | SC |
| Issuer | MEDICAID |
| Number | Q069472 |
| State | TN |
| Issuer | MEDICAID |
| Number | 30003947130002 |
| State | KS |
| Issuer | MEDICAID |
| Number | 003214508A |
| State | GA |
| Issuer | MEDICAID |
| Number | 02244535 |
| State | NY |
| Issuer | MEDICAID |
| Number | 10026760900 |
| State | NE |
| Issuer | MEDICAID |
| Number | 1245720820 |
| State | SD |
| Issuer | MEDICAID |
| Number | 2488171 |
| State | LA |
| Issuer | MEDICAID |
| Number | 1245720820 |
| State | MT |
| Issuer | MEDICAID |
| Number | 1245720820 |
| State | ME |
| Issuer | MEDICAID |
| Number | 504222 |
| State | AZ |
| Issuer | MEDICAID |
| Number | 700066284 |
| State | MO |
| CIK number | Mailing Address | Business Address | Phone | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1141874 | 21250 HAWTHORNE BLVD SUITE 800, 21250 HAWTHORNE BLVD SUITE 800, TORRANCE, CA, 90503-5517 | 21250 HAWTHORNE BLVD, SIE 800, TORRANCE, CA, 90503-5517 | 3107922600 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Form type | 424B5 |
| File number | 333-203394-06 |
| Filing date | 2015-04-15 |
| File | View File |
Filings since 2015-04-14
| Form type | 424B5 |
| File number | 333-203394-06 |
| Filing date | 2015-04-14 |
| File | View File |
Filings since 2015-04-14
| Form type | S-3ASR |
| File number | 333-203394-06 |
| Filing date | 2015-04-14 |
| File | View File |
Filings since 2014-06-12
| Form type | 424B5 |
| File number | 333-196630-09 |
| Filing date | 2014-06-12 |
| File | View File |
Filings since 2014-06-11
| Form type | 424B5 |
| File number | 333-196630-09 |
| Filing date | 2014-06-11 |
| File | View File |
Filings since 2014-06-10
| Form type | 424B5 |
| File number | 333-196630-09 |
| Filing date | 2014-06-10 |
| File | View File |
Filings since 2014-06-10
| Form type | S-3ASR |
| File number | 333-196630-09 |
| Filing date | 2014-06-10 |
| File | View File |
Filings since 2012-08-15
| Form type | 424B5 |
| File number | 333-183285-07 |
| Filing date | 2012-08-15 |
| File | View File |
Filings since 2012-08-14
| Form type | 424B5 |
| File number | 333-183285-07 |
| Filing date | 2012-08-14 |
| File | View File |
Filings since 2012-08-13
| Form type | S-3ASR |
| File number | 333-183285-07 |
| Filing date | 2012-08-13 |
| File | View File |
Filings since 2010-10-07
| Form type | 424B5 |
| File number | 333-169690-13 |
| Filing date | 2010-10-07 |
| File | View File |
Filings since 2010-10-01
| Form type | 424B5 |
| File number | 333-169690-13 |
| Filing date | 2010-10-01 |
| File | View File |
Filings since 2010-09-30
| Form type | S-3ASR |
| File number | 333-169690-13 |
| Filing date | 2010-09-30 |
| File | View File |
Filings since 2007-06-15
| Form type | 424B3 |
| File number | 333-143001-19 |
| Filing date | 2007-06-15 |
| File | View File |
Filings since 2007-06-13
| Form type | EFFECT |
| File number | 333-143001-19 |
| Filing date | 2007-06-13 |
| File | View File |
Filings since 2007-05-16
| Form type | S-4 |
| File number | 333-143001-19 |
| Filing date | 2007-05-16 |
| File | View File |
Filings since 2005-07-26
| Form type | 424B3 |
| File number | 333-126398-07 |
| Filing date | 2005-07-26 |
| File | View File |
Filings since 2005-07-05
| Form type | S-4 |
| File number | 333-126398-07 |
| Filing date | 2005-07-05 |
| File | View File |
Filings since 2001-06-20
| Form type | 424B3 |
| File number | 333-62552-30 |
| Filing date | 2001-06-20 |
| File | View File |
Filings since 2001-06-08
| Form type | S-4 |
| File number | 333-62552-30 |
| Filing date | 2001-06-08 |
| File | View File |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Staffieri, Michael D. | President | 3000 DaVita Way, DeLand, FL 32724 |
| Name | Role | Address |
|---|---|---|
| Staffieri, Michael D. | Director | 3000 DaVita Way, DeLand, FL 32724 |
| Name | Role | Address |
|---|---|---|
| Berberich, Stephanie N. | Secretary | 3000 DaVita Way, DeLand, FL 32724 |
| Name | Role | Address |
|---|---|---|
| Berry, Christopher M. | Treasurer | 3000 DaVita Way, DeLand, FL 32724 |
| Name | Role | Address |
|---|---|---|
| Berry, Christopher M. | Chief Accounting Officer | 3000 DaVita Way, DeLand, FL 32724 |
| Name | Role | Address |
|---|---|---|
| Caldwell, Samantha A. | Authorized Representative | 3000 DaVita Way, DeLand, FL 32724 |
| Name | Role | Address |
|---|---|---|
| Ware, Bruce | Vice President | 3000 DaVita Way, DeLand, FL 32724 |
| Iqbal, MD, Jameel | Vice President | 3000 DaVita Way, DeLand, FL 32724 |
| King, JoAnne | Vice President | 3000 DaVita Way, DeLand, FL 32724 |
| Wagner, Keri | Vice President | 3000 DaVita Way, DeLand, FL 32724 |
| Name | Role | Address |
|---|---|---|
| Ware, Bruce | Finance | 3000 DaVita Way, DeLand, FL 32724 |
| Name | Role | Address |
|---|---|---|
| Wagner, Keri | General Manager | 3000 DaVita Way, DeLand, FL 32724 |
| Name | Role | Address |
|---|---|---|
| McKinnon, Patrick j. | Chief Financial Officer | 3000 DaVita Way, DeLand, FL 32724 |
| Name | Role | Address |
|---|---|---|
| Fujikawa, Ryan | Assistant Secretary | 3000 DaVita Way, DeLand, FL 32724 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000002567 | DAVITA LABS | ACTIVE | 2017-01-07 | 2027-12-31 | No data | 3000 DA VITA WAY, DELAND, FL, 32724 |
| G11000061677 | DAVITA LABS | EXPIRED | 2011-06-20 | 2016-12-31 | No data | 1991 INDUSTRIAL DRIVE, DELAND, FL, 32724 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-14 | 3000 DaVita Way, DeLand, FL 32724 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-14 | 3000 DaVita Way, DeLand, FL 32724 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-04-23 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-08-22 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| NAME CHANGE AMENDMENT | 1998-07-24 | TOTAL RENAL LABORATORIES, INC. | No data |
| NAME CHANGE AMENDMENT | 1994-09-13 | DIALYSIS LABORATORIES, INC. | No data |
| AMENDMENT | 1994-02-03 | No data | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-05-02 |
| ANNUAL REPORT | 2024-04-20 |
| AMENDED ANNUAL REPORT | 2023-05-09 |
| AMENDED ANNUAL REPORT | 2023-05-08 |
| ANNUAL REPORT | 2023-04-14 |
| AMENDED ANNUAL REPORT | 2022-05-13 |
| ANNUAL REPORT | 2022-04-20 |
| AMENDED ANNUAL REPORT | 2021-12-01 |
| AMENDED ANNUAL REPORT | 2021-11-23 |
| AMENDED ANNUAL REPORT | 2021-07-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
