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