| 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 |
| NAICS: | 621112 - Offices of Physicians, Mental Health Specialists |
| Historical names: |
THE TAVARES PEDIATRIC CENTER, INC. |
| 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: 05 Oct 2024
Sources: Rhode Island Department of State
