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FLOR DIALYSIS, LLC

Details

Name: FLOR DIALYSIS, LLC
Jurisdiction: Alabama
Legal type: Foreign Limited Liability Company
Status: Exists
Date of registration: 01 Feb 2011 (14 years ago) (Companies founded in February 2011)
Entity Number: 000-007-394
Register Number: 000007394
ZIP code: 36104 (Companies in Montgomery, 36104)
County: Montgomery
Place of Formation: Delaware
Principal Address: 601 HAWAII STREETEL SEGUNDO, CA 90245
Registered Office Street Address: 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1215234992 2011-02-16 2024-08-26 5200 VIRGINIA WAY, L&C DEPARTMENT, BRENTWOOD, TN, 370277569, US 1809 AVENUE H, BIRMINGHAM, AL, 352181542, US

Contacts

Phone +1 205-785-2972
Fax 2057863317

Authorized person

Name SAMUEL T WEY
Role VP LICENSURE & CERTIFICATION
Phone 6153416641

Taxonomy

Taxonomy Code 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number S3730
State AL
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 134545
State AL

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
6GWX1 Active Non-Manufacturer 2011-08-08 2024-02-13 2028-02-15 2024-02-13

Contact Information

POC DONNA BRAWLEY
Phone +1 253-382-1493
Fax +1 888-577-9570
Address 300 22ND ST S, BIRMINGHAM, AL, 35233 2209, UNITED STATES

Ownership of Offeror Information

Highest Level Owner Information not Available
Immediate Level Owner
Vendor Certified 2023-02-15
CAGE number 45JM2
Company Name DAVITA INC.
CAGE Last Updated 2024-03-29
List of Offerors (0) Information not Available

Agent

Name Role Address
CORPORATION SERVICE COMPANY INC Agent 251 LITTLE FALLS DRIVEWILMINGTON, DE 19808

Date of last update: 30 Jul 2024

Sources: Alabama Secretary of State