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LIBERTY DIALYSIS-IDAHO FALLS LLC

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Company Details

Name: LIBERTY DIALYSIS-IDAHO FALLS LLC
Jurisdiction: Idaho
Legal type: Foreign Limited Liability Company
Status: Active-Existing
Date of registration: 22 Nov 2006 (19 years ago)
Financial Date End: 30 Nov 2025
Entity Number: 180631
Place of Formation: DELAWARE
File Number: 180631
Principal Address: 920 WINTER ST TAX DEPT WALTHAM, MA 2451
Mailing Address: 920 WINTER ST. WALTHAM, MA 02451

Member

Name Role Address Appointed On Resigned On
Liberty Idaho Falls 2 LLC Member 920 WINTER ST., WALTHAM, MA 02451 2020-11-25 No data
Liberty Dialysis, LLC Member 920 WINTER ST., WALTHAM, MA 02451 2023-10-09 2023-10-09

Agent

Name Role Address
BOISE DIALYSIS LLC Agent MICHELLE NELSON, 3525 E LOUISE DR STE 100, MERIDIAN, ID 83642

National Provider Identifier

NPI Number:
1487692950
Certification Date:
2023-10-17

Authorized Person:

Name:
MR. BARRY L. BLANTON
Role:
VICE PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2085238502

Filing

Filing Name Filing Number Filing date
Annual Report 0005941209 2024-10-14
Annual Report 0005436038 2023-10-09
Annual Report 0004939584 2022-10-05
Annual Report 0004432784 2021-10-02
Annual Report 0004074625 2020-11-25

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Date of last update: 28 May 2025

Sources: Idaho Secretary of State