| Entity Name: | ATLANTIC KIDNEY CENTERS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 18 Oct 1994 (30 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 29 Apr 1996 (29 years ago) |
| Document Number: | P94000076450 |
| FEI/EIN Number | 65-0534325 |
| Address: | 4700 N. CONGRESS AVENUE, SUITE 106, WEST PALM BEACH, FL 33407 |
| Mail Address: | 2700 Donald Ross Road, Apt. 312, Aapt. 312, Palm Beach Gardens, FL 33410-1112 |
| ZIP code: | 33407 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881675239 | 2005-11-10 | 2020-08-22 | 4700 N CONGRESS AVE, STE 104, WEST PALM BEACH, FL, 334073282, US | 4700 N CONGRESS AVE, STE 104, WEST PALM BEACH, FL, 334073282, US | |||||||||||||||||||||||||||||
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| Phone | +1 561-845-2888 |
| Fax | 5618457282 |
Authorized person
| Name | MS. MARIETTA HOLMES |
| Role | ADMINISTRATOR |
| Phone | 5618452888 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AMERIGROUP |
| Number | 209348 |
| Issuer | MEDICAID |
| Number | 21209330 |
| State | FL |
| Issuer | BCBS OF FL |
| Number | V7Q |
| Name | Role | Address |
|---|---|---|
| RAPPAPORT, MARIETTA | Agent | 4700 N. CONGRESS AVENUE, SUITE 106, WEST PALM BEACH, FL 33407 |
| Name | Role | Address |
|---|---|---|
| Rappaport, Kenneth A | Director | 2700 Donald Ross Road, Apt. 312 Palm Beach Gardens, FL 33410 |
| WATERMAN, JACK | Director | 729 Charlestown Circle, Palm Beach Gardens, FL 33410 |
| Rappaport, M A | Director | 2700 Donald Ross Road, Apt. 312 Palm Beach Gardens, FL 33410 |
| Name | Role | Address |
|---|---|---|
| Rappaport, Kenneth A | President | 2700 Donald Ross Road, Apt. 312 Palm Beach Gardens, FL 33410 |
| Name | Role | Address |
|---|---|---|
| WATERMAN, JACK | Treasurer | 729 Charlestown Circle, Palm Beach Gardens, FL 33410 |
| Name | Role | Address |
|---|---|---|
| Rappaport, M A | Secretary | 2700 Donald Ross Road, Apt. 312 Palm Beach Gardens, FL 33410 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-04-29 | 4700 N. CONGRESS AVENUE, SUITE 106, WEST PALM BEACH, FL 33407 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-03-21 | 4700 N. CONGRESS AVENUE, SUITE 106, WEST PALM BEACH, FL 33407 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-03-21 | 4700 N. CONGRESS AVENUE, SUITE 106, WEST PALM BEACH, FL 33407 | No data |
| REGISTERED AGENT NAME CHANGED | 2011-01-10 | RAPPAPORT, MARIETTA | No data |
| REINSTATEMENT | 1996-04-29 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1995-08-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-09 |
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-02-13 |
| ANNUAL REPORT | 2022-02-22 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2019-04-23 |
| ANNUAL REPORT | 2018-03-28 |
| ANNUAL REPORT | 2017-02-07 |
| ANNUAL REPORT | 2016-02-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
