| Entity Name: | UNIVERSAL KIDNEY CENTER OF BOYNTON BEACH, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 02 Jun 1999 (26 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 14 Jun 2001 (24 years ago) |
| Document Number: | P99000049573 |
| FEI/EIN Number | 65-0924725 |
| Mail Address: | 4875 NE 20TH TERRACE, FT. LAUDERDALE, FL 33308 |
| Address: | 4895 WINDWARD PASSAGE DRIVE, UNIT 5, BOYNTON BEACH, FL 33436 |
| ZIP code: | 33436 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245342658 | 2006-08-31 | 2015-10-06 | 4895 WINDWARD PASSAGE DRIVE, SUITE #5, BOYNTON BEACH, FL, 334367741, US | 4895 WINDWARD PASSAGE DRIVE, SUITE #5, BOYNTON BEACH, FL, 334367741, US | |||||||||||||||||||||||||||||||
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| Phone | +1 561-740-1981 |
| Fax | 5617328288 |
Authorized person
| Name | MR. ELMO ANGELO V BARTOLOME |
| Role | CFO COO |
| Phone | 9547706540 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| License Number | CLEA LIC # 800017018 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF FL |
| Number | VE9 |
| State | FL |
| Issuer | MEDICAID |
| Number | 890071000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BARTOLOME, ELMO | Agent | 4895 WINDWARD PASSAGE DR, SUITE 5, BOYNTON BEACH, FL 33436 |
| Name | Role | Address |
|---|---|---|
| BARTOLOME, ELMO V | President | 4895 WINDWARD PASSAGE DR #5, BOYNTON BEACH, FL 33436 |
| Name | Role | Address |
|---|---|---|
| BARTOLOME, ELMO V | Vice President | 4895 WINDWARD PASSAGE DR #5, BOYNTON BEACH, FL 33436 |
| Name | Role | Address |
|---|---|---|
| BARTOLOME, ELMO V | Secretary | 4895 WINDWARD PASSAGE DR #5, BOYNTON BEACH, FL 33436 |
| Name | Role | Address |
|---|---|---|
| BARTOLOME, ELMO V | Treasurer | 4895 WINDWARD PASSAGE DR #5, BOYNTON BEACH, FL 33436 |
| Name | Role | Address |
|---|---|---|
| BARTLOME, DELILAH | Director | 4895 WINDWARD PASSAGE DR #5, BOYNTON BEACH, FL 33436 |
| Name | Role | Address |
|---|---|---|
| BARTLOME, DELILAH | Chief Executive Officer | 4895 WINDWARD PASSAGE DR #5, BOYNTON BEACH, FL 33436 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2014-04-23 | 4895 WINDWARD PASSAGE DRIVE, UNIT 5, BOYNTON BEACH, FL 33436 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2002-10-08 | 4895 WINDWARD PASSAGE DRIVE, UNIT 5, BOYNTON BEACH, FL 33436 | No data |
| AMENDMENT | 2001-06-14 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2001-03-29 | 4895 WINDWARD PASSAGE DR, SUITE 5, BOYNTON BEACH, FL 33436 | No data |
| REGISTERED AGENT NAME CHANGED | 2000-06-05 | BARTOLOME, ELMO | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J24000313286 | TERMINATED | 1000000993877 | BROWARD | 2024-05-16 | 2034-05-22 | $ 551.30 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-27 |
| ANNUAL REPORT | 2023-04-05 |
| ANNUAL REPORT | 2022-03-09 |
| ANNUAL REPORT | 2021-04-02 |
| ANNUAL REPORT | 2020-03-26 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-03-27 |
| ANNUAL REPORT | 2017-03-21 |
| ANNUAL REPORT | 2016-03-28 |
| ANNUAL REPORT | 2015-04-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
