| Name: | BLOCK ISLAND HEALTH SERVICES, INC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Non-Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 23 Jul 1984 (41 years ago) |
| Identification Number: | 000027470 |
| ZIP code: | 02807 |
| County: | Washington County |
| Principal Address: | PO BOX 919, BLOCK ISLAND, RI, 02807, USA |
| Purpose: | PROVISION OF HEALTH CARE SERVICES |
| NAICS: | 813212 - Voluntary Health Organizations |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639649452 | 2018-12-05 | 2018-12-05 | PO BOX 919, BLOCK ISLAND, RI, 028070919, US | 6 PAYNE ROAD, BLOCK ISLAND, RI, 028070919, US | |||||||||||||||||||||
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| Phone | +1 401-466-2974 |
| Fax | 4014665476 |
Authorized person
| Name | PATRICIA ANN MURPHY |
| Role | BILLING COORDINATOR |
| Phone | 4014662974 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9002424 |
| State | RI |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BLOCK ISLAND HEALTH SERVICES, INC. 403(B) PLAN | 2023 | 222570482 | 2024-06-10 | BLOCK ISLAND HEALTH SERVICES, INC. | 13 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-06-10 |
| Name of individual signing | THOMAS WARCUP |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 4014662974 |
| Plan sponsor’s address | 6 PAYNE ROAD, BLOCK ISLAND, RI, 02807 |
Signature of
| Role | Plan administrator |
| Date | 2024-06-17 |
| Name of individual signing | THOMAS WARCUP |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 4014662974 |
| Plan sponsor’s address | 6 PAYNE ROAD, BLOCK ISLAND, RI, 02807 |
Signature of
| Role | Plan administrator |
| Date | 2023-02-21 |
| Name of individual signing | DEBBI-JO HORTON |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 4014662974 |
| Plan sponsor’s address | 6 PAYNE ROAD, BLOCK ISLAND, RI, 02807 |
| Name | Role | Address |
|---|---|---|
| JAMES DUTRA | Agent | 117 METRO CENTER BLVD SUITE 2007, WARWICK, RI, 02886, USA |
| Name | Role | Address |
|---|---|---|
| SUSAN STOVER | PRESIDENT | PO BOX 1435 BLOCK ISLAND, RI 02807 USA |
| Name | Role | Address |
|---|---|---|
| TOM MURPHY | TREASURER | PO BOX 919 BLOCK ISLAND, RI 02807 USA |
| Name | Role | Address |
|---|---|---|
| BRIAN OTT | SECRETARY | PO BOX 919 BLOCK ISLAND, RI 02807 USA |
| Name | Role | Address |
|---|---|---|
| THOMAS WARCUP MD | CEO | PO BOX 919 BLOCK ISLAND, RI 02807 USA |
| Name | Role | Address |
|---|---|---|
| LAURA PARSONS | VICE PRESIDENT | PO BOX 919 BLOCK ISLAND, RI 02807 USA |
| Name | Role | Address |
|---|---|---|
| PAM AUSTEN | DIRECTOR | PO BOX 919 BLOCK ISLAND, RI 02807 USA |
| BILL MILLS | DIRECTOR | PO BOX 919 BLOCK ISLAND, RI 02807 USA |
| PAM RICHTER | DIRECTOR | PO BOX 919 BLOCK ISLAND, RI 02807 USA |
| KIRK LITTLEFIELD | DIRECTOR | PO BOX 919 BLOCK ISLAND, RI 02807 USA |
| ROBIN LEWIS | DIRECTOR | PO BOX 919 BLOCK ISLAND, RI 02807 USA |
| SHARON WEINBERG | DIRECTOR | PO BOX 919 BLOCK ISLAND, RI 02807 USA |
| Number | Name | File Date |
|---|---|---|
| 202452395130 | Statement of Change of Registered/Resident Agent | 2024-04-24 |
| 202452394160 | Annual Report | 2024-04-24 |
| 202329384470 | Annual Report | 2023-02-27 |
| 202214418020 | Annual Report | 2022-04-11 |
| 202198697950 | Annual Report | 2021-06-28 |
| 202041326970 | Annual Report | 2020-06-02 |
| 202034138050 | Annual Report | 2020-02-10 |
| 202034137990 | Reinstatement | 2020-02-10 |
| 202032375600 | Revocation Certificate For Failure to File the Annual Report for the Year | 2020-01-15 |
| 201927016190 | Revocation Notice For Failure to File An Annual Report | 2019-11-06 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
