| Name: | Wampanoag Medical Clinic and Treatment Center |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 09 Apr 1976 (49 years ago) |
| Date of Dissolution: | 09 Nov 2010 (14 years ago) |
| Date of Status Change: | 09 Nov 2010 (14 years ago) |
| Identification Number: | 000015695 |
| ZIP code: | 02914 |
| County: | Providence County |
| Principal Address: | 1970 PAWTUCKET AVENUE, EAST PROVIDENCE, RI, 02914, USA |
| Purpose: | HEALTH CARE SERVICES |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720011018 | 2006-07-09 | 2020-08-22 | 1970 PAWTUCKET AVE, EAST PROVIDENCE, RI, 029141718, US | 1970 PAWTUCKET AVE, EAST PROVIDENCE, RI, 029141718, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 401-438-6620 |
| Fax | 4014386621 |
Authorized person
| Name | DR. JUANITO A ABANILLA |
| Role | PRESIDENT |
| Phone | 4014386620 |
Taxonomy
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| License Number | MD4452 |
| State | RI |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JUANITO ABANILLA, MD | Agent | 1970 PAWTUCKET AVENUE, EAST PROVIDENCE, RI, 02914, USA |
| Name | Role | Address |
|---|---|---|
| JUANITO ABANILLA MD | PRESIDENT | 1970 PAWTUCKET AVENUE EAST PROVIDENCE, RI 02914 USA |
| Number | Name | File Date |
|---|---|---|
| 201072583600 | Registered Office Not Maintained | 2010-11-29 |
| 201071988370 | Revocation Certificate For Failure to File the Annual Report for the Year | 2010-11-09 |
| 201064706000 | Registered Office Not Maintained | 2010-06-28 |
| 201063040970 | Revocation Notice For Failure to File An Annual Report | 2010-06-16 |
| 200943269830 | Annual Report | 2009-02-26 |
| 200805389610 | Annual Report | 2008-01-10 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
