| Entity Name: | DIALYSIS AND KIDNEY CENTER OF NORTH BREVARD, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 21 Sep 1992 (32 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 25 Nov 2019 (5 years ago) |
| Document Number: | V66227 |
| FEI/EIN Number | 59-3155506 |
| Address: | 951 N Washington Avenue, TITUSVILLE, FL 32796 |
| Mail Address: | 951 N Washington Avenue, TITUSVILLE, FL 32796 |
| ZIP code: | 32796 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346358538 | 2006-08-28 | 2010-06-03 | PO BOX 1067, MIMS, FL, 327541067, US | 830 CENTURY MEDICAL DR, SUITE C, TITUSVILLE, FL, 327962149, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 321-269-6270 |
| Fax | 3213831625 |
Authorized person
| Name | JEANETTE P DEE |
| Role | ADMINISTRATOR |
| Phone | 3212696270 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| License Number | 05 0904 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 0899219 |
| State | FL |
| Issuer | BLUE SHIELD |
| Number | V4G |
| State | FL |
| Issuer | MEDICAID |
| Number | 210743100 |
| State | FL |
| Name | Role |
|---|---|
| NORTH BREVARD MEDICAL SUPPORT, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| MCALPINE, CHRISTOPHER | Secretary | 951 North Washingotn Avenue, TITUSVILLE, FL 32796 |
| Name | Role | Address |
|---|---|---|
| MCALPINE, CHRISTOPHER | Vice President | 951 North Washingotn Avenue, TITUSVILLE, FL 32796 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2019-11-25 | 951 North Washington Avenue, TITUSVILLE, FL 32796 | No data |
| REINSTATEMENT | 2019-11-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2018-11-19 | 951 N Washington Avenue, TITUSVILLE, FL 32796 | No data |
| REINSTATEMENT | 2018-11-19 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-11-19 | 951 N Washington Avenue, TITUSVILLE, FL 32796 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2014-08-07 | NORTH BREVARD MEDICAL SUPPORT, INC. | No data |
| REINSTATEMENT | 2014-05-12 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J02000312268 | TERMINATED | 0000485731 | 04633 02403 | 2002-07-10 | 2007-08-06 | $ 2,303.52 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, COCOA SERVICE CENTER, 2428 CLEARLAKE ROAD, COCOA, FL329225710 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-11 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-01-16 |
| REINSTATEMENT | 2019-11-25 |
| REINSTATEMENT | 2018-11-19 |
| ANNUAL REPORT | 2016-03-04 |
| ANNUAL REPORT | 2015-01-13 |
| AMENDED ANNUAL REPORT | 2014-08-07 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
