| Name: | THE FORMER TAVARES PEDIATRIC CENTER, INC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 22 Dec 1980 (44 years ago) |
| Date of Dissolution: | 06 Dec 2021 (3 years ago) |
| Date of Status Change: | 06 Dec 2021 (3 years ago) |
| Identification Number: | 000009070 |
| Principal Address: | 591 WARREN AVENUE, SWANSEA, MA, 02777, USA |
| Purpose: | THE OPERATION AND EXTENDED CARE AND SKILLED NURSING FACILITY FOR CHILDREN |
| Historical names: |
THE TAVARES PEDIATRIC CENTER, INC. |
NAICS
621112 Offices of Physicians, Mental Health SpecialistsThis U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of psychiatry or psychoanalysis. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366442899 | 2005-07-27 | 2020-08-22 | 101 PLAIN ST, PROVIDENCE, RI, 029034824, US | 101 PLAIN ST, PROVIDENCE, RI, 029034824, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 401-272-7127 |
| Fax | 4012724752 |
Authorized person
| Name | MR. EUGENE F TAVARES |
| Role | ADMINISTRATOR |
| Phone | 4012727127 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | RI 642 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 315P00000X - Intellectual Disabilities Intermediate Care Facility |
| License Number | RI 642 |
| State | RI |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 41G085 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| MICHAEL G. TAUBER, ESQ. | Agent | CAMERON & MITTLEMAN LLP 301 PROMENADE STREET, PROVIDENCE, RI, 02908, USA |
| Name | Role | Address |
|---|---|---|
| VIVIAN M. TAVARES | TREASURER | 591 WARREN AVENUE SWANSEA, MA 02777 USA |
| Name | Role | Address |
|---|---|---|
| VIVIAN M. TAVARES | SECRETARY | 591 WARREN AVENUE SWANSEA, MA 02777 USA |
| Name | Role | Address |
|---|---|---|
| VIVIAN M. TAVARES | PRESIDENT | 591 WARREN AVENUE SWANSEA, MA 02777 USA |
| Name | Role | Address |
|---|---|---|
| VIVIAN M. TAVARES | DIRECTOR | 591 WARREN AVENUE SWANSEA, MA 02777 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2020-11-05 | THE TAVARES PEDIATRIC CENTER, INC. | THE FORMER TAVARES PEDIATRIC CENTER, INC. |
| Number | Name | File Date |
|---|---|---|
| 202106857920 | Articles of Dissolution | 2021-12-06 |
| 202100601510 | Statement of Change of Registered/Resident Agent | 2021-09-01 |
| 202193597480 | Annual Report - Amended | 2021-03-04 |
| 202193596690 | Annual Report | 2021-03-04 |
| 202192516130 | Statement of Change of Registered/Resident Agent | 2021-02-22 |
| 202071966960 | Articles of Amendment | 2020-11-05 |
| 202034284180 | Annual Report | 2020-02-12 |
| 201987590520 | Annual Report | 2019-02-22 |
| 201857135460 | Annual Report | 2018-01-29 |
| 201754905210 | Statement of Change of Registered/Resident Agent | 2017-12-11 |
Date of last update: 06 Apr 2025
Sources: Rhode Island Department of State
