| Name: | DVA Healthcare of Tuscaloosa, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 15 Nov 1995 (29 years ago) (Companies founded in November 1995) |
| Entity Number: | 000-602-552 |
| Register Number: | 000602552 |
| Historical Names: |
Gambro Healthcare of Tuscaloosa, L.L.C.
|
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Tennessee |
| Principal Address: | 10810 W COLLINS AVE LEGAL DEPARTMENTLAKEWOOD, CO 80215-4439 |
| Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
Activities
OWN/OPERATE/FINANCE/PROVIDE FOR MGMT OF OUTPATIENT DIALYSIS SVS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396059382 | 2010-08-02 | 2023-05-19 | 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US | 289 WILLIAM E HILL DR, SUITE A, CARROLLTON, AL, 354473247, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 615-320-4268 |
| Fax | 8772380567 |
| Phone | +1 205-367-1194 |
| Fax | 2053671248 |
Authorized person
| Name | JOHN WINSTEL |
| Role | CHIEF ACCOUNTING OFFICER |
| Phone | 2537334501 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| License Number | S5401 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 127512 |
| State | AL |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5XNZ8 | Active | Non-Manufacturer | 2010-03-18 | 2023-09-20 | 2027-09-22 | 2023-09-20 | |||||||||||||||||||||||
|
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| POC | DONNA BRAWLEY |
| Phone | +1 253-382-1493 |
| Fax | +1 888-577-9570 |
| Address | 2450 TEMPLE AVE N, FAYETTE, AL, 35555 1160, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | |
|---|---|
| Vendor Certified | 2022-09-22 |
| 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 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2005-10-14 | Name Change | Gambro Healthcare of Tuscaloosa, L.L.C. | DVA Healthcare of Tuscaloosa, LLC |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
