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DANIEL T. SHREVE, M.D., INC.

Company Details

Name: DANIEL T. SHREVE, M.D., INC.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Dissolved
Date of Organization in Rhode Island: 20 Mar 1978 (47 years ago)
Date of Dissolution: 14 Dec 2020 (4 years ago)
Date of Status Change: 14 Dec 2020 (4 years ago)
Identification Number: 000011175
Principal Address: C/O 55 ROBINCREST COURT, SEEKONK, MA, 02771, USA
Purpose: PHYSICIAN, MEDICAL OFFICE/PRACTICE AND SERVICES
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1619017308 2007-02-08 2012-10-17 5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA, 921211705, US 47 HAZARD AVE, EAST PROVIDENCE, RI, 029143309, US

Contacts
Phone +1 858-625-2990
Phone +1 401-434-9100

Authorized person
Name KENNY HEINE
Role DIRECTOR OF OPERATIONS
Phone 8586252990

Taxonomy
Taxonomy Code 332900000X - Non-Pharmacy Dispensing Site
License Number MD03558
State RI
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DANIEL T. SHREVE, M.D., INC. PROFIT SHARING PLAN 2017 050376045 2018-07-16 DANIEL T. SHREVE, M.D., INC. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-03-20
Business code 621111
Sponsor’s telephone number 4014349100
Plan sponsor’s address 47 HAZARD AVENUE, EAST PROVIDENCE, RI, 02914
DANIEL T. SHREVE, M.D., INC. PROFIT SHARING PLAN 2016 050376045 2017-04-28 DANIEL T. SHREVE, M.D., INC. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-03-20
Business code 621111
Sponsor’s telephone number 4014349100
Plan sponsor’s address 47 HAZARD AVENUE, EAST PROVIDENCE, RI, 02914
DANIEL T. SHREVE, M.D., INC. PROFIT SHARING PLAN 2015 050376045 2016-04-20 DANIEL T. SHREVE, M.D., INC. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-03-20
Business code 621111
Sponsor’s telephone number 4014349100
Plan sponsor’s address 47 HAZARD AVENUE, EAST PROVIDENCE, RI, 02914
DANIEL T. SHREVE, M.D., INC. PROFIT SHARING PLAN 2014 050376045 2015-03-31 DANIEL T. SHREVE, M.D., INC. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-03-20
Business code 621111
Sponsor’s telephone number 4014349100
Plan sponsor’s address 47 HAZARD AVENUE, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2015-03-31
Name of individual signing DANIEL SHREVE
Valid signature Filed with authorized/valid electronic signature
DANIEL T. SHREVE, M.D., INC. PROFIT SHARING PLAN 2013 050376045 2014-04-04 DANIEL T. SHREVE, M.D., INC. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-03-20
Business code 621111
Sponsor’s telephone number 4014349100
Plan sponsor’s address 47 HAZARD AVENUE, EAST PROVIDENCE, RI, 02914

Signature of
Role Plan administrator
Date 2014-04-04
Name of individual signing DANIEL SHREVE
Valid signature Filed with authorized/valid electronic signature
DANIEL T. SHREVE, M.D., INC. PROFIT SHARING PLAN 2012 050376045 2013-07-01 DANIEL T. SHREVE, M.D., INC. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-03-20
Business code 621111
Sponsor’s telephone number 4014349100
Plan sponsor’s address 47 HAZARD AVENUE, EAST PROVIDENCE, RI, 02914

Plan administrator’s name and address
Administrator’s EIN 050376045
Plan administrator’s name DANIEL T. SHREVE, M.D., INC.
Plan administrator’s address 47 HAZARD AVENUE, EAST PROVIDENCE, RI, 02914
Administrator’s telephone number 4014349100

Signature of
Role Plan administrator
Date 2013-07-01
Name of individual signing DANIEL SHREVE
Valid signature Filed with authorized/valid electronic signature
DANIEL T. SHREVE, M.D., INC. PROFIT SHARING PLAN 2011 050376045 2012-07-18 DANIEL T. SHREVE, M.D., INC. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-03-20
Business code 621111
Sponsor’s telephone number 4014349100
Plan sponsor’s address 47 HAZARD AVENUE, EAST PROVIDENCE, RI, 02914

Plan administrator’s name and address
Administrator’s EIN 050376045
Plan administrator’s name DANIEL T. SHREVE, M.D., INC.
Plan administrator’s address 47 HAZARD AVENUE, EAST PROVIDENCE, RI, 02914
Administrator’s telephone number 4014349100

Signature of
Role Plan administrator
Date 2012-07-18
Name of individual signing DANIEL SHREVE
Valid signature Filed with authorized/valid electronic signature
DANIEL T. SHREVE, M.D., INC. PROFIT SHARING PLAN 2010 050376045 2011-07-19 DANIEL T. SHREVE, M.D., INC. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-03-20
Business code 621111
Sponsor’s telephone number 4014349100
Plan sponsor’s address 47 HAZARD AVENUE, EAST PROVIDENCE, RI, 029143309

Plan administrator’s name and address
Administrator’s EIN 050376045
Plan administrator’s name DANIEL T. SHREVE, M.D., INC.
Plan administrator’s address 47 HAZARD AVENUE, EAST PROVIDENCE, RI, 029143309
Administrator’s telephone number 4014349100

Signature of
Role Plan administrator
Date 2011-07-19
Name of individual signing DANIEL SHREVE
Valid signature Filed with authorized/valid electronic signature
DANIEL T. SHREVE, M.D., INC. PROFIT SHARING PLAN 2009 050376045 2010-10-12 DANIEL T. SHREVE, M.D., INC. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-03-20
Business code 621111
Sponsor’s telephone number 4014349100
Plan sponsor’s address 47 HAZARD AVENUE, EAST PROVIDENCE, RI, 029143309

Plan administrator’s name and address
Administrator’s EIN 050376045
Plan administrator’s name DANIEL T. SHREVE, M.D., INC.
Plan administrator’s address 47 HAZARD AVENUE, EAST PROVIDENCE, RI, 029143309
Administrator’s telephone number 4014349100

Signature of
Role Plan administrator
Date 2010-10-12
Name of individual signing DANIEL SHREVE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DANIEL T. SHREVE Agent 47 HAZARD AVENUE, EAST PROVIDENCE, RI, 02914, USA

PRESIDENT

Name Role Address
DANIEL T SHREVE PRESIDENT 55 ROBINCREST COURT SEEKONK, MA 02771- USA

Filings

Number Name File Date
202079801010 Articles of Dissolution 2020-12-14
202037116460 Annual Report 2020-04-01
201920364720 Annual Report 2019-09-18
201906953050 Revocation Notice For Failure to File An Annual Report 2019-07-24
201855988400 Annual Report 2018-01-11
201734686890 Annual Report 2017-02-24
201692438160 Annual Report 2016-02-15
201555120380 Annual Report 2015-02-16
201432270300 Annual Report 2014-01-02
201312247200 Annual Report 2013-02-21

Related by officers

No related officers

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Date of last update: 05 Oct 2024

Sources: Rhode Island Department of State

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