| Name: | The Providence Community Health Centers, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Non-Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 01 Mar 1976 (49 years ago) |
| Identification Number: | 000028183 |
| ZIP code: | 02905 |
| County: | Providence County |
| Principal Address: | 375 ALLENS AVENUE, PROVIDENCE, RI, 02905, USA |
| Purpose: | HEALTH CARE |
| NAICS: | 813212 - Voluntary Health Organizations |
| Historical names: |
Providence Ambulatory Health Care Foundation, Inc. The Providence Community Health Centers, Inc. The Providence Community Health Centers |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013628965 | 2022-12-12 | 2022-12-12 | 375 ALLENS AVE, PROVIDENCE, RI, 029055010, US | 145 BEAUFORT ST, PROVIDENCE, RI, 029083929, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 401-780-2511 |
| Fax | 4017802565 |
| Phone | +1 888-612-7242 |
| Fax | 4014440421 |
Authorized person
| Name | BRENDA CHARPENTIER |
| Role | CREDENTIALING SPECIALIST |
| Phone | 4017802511 |
Taxonomy
| Taxonomy Code | 261QF0400X - Federally Qualified Health Center (FQHC) |
| Is Primary | Yes |
| LEI number | Registered As | Jurisdiction Of Formation | General Category | Entity Status | Entity created at | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5493002WI5AH87SMWM59 | 000028183 | US-RI | GENERAL | ACTIVE | No data | |||||||||||||||||||
|
||||||||||||||||||||||||
| Legal | C/O MERRILL R. THOMAS, 375 ALLENS AVENUE, PROVIDENCE, US-RI, US, 02905 |
| Headquarters | C/O Merrill R. Thomas, 375 Allens Avenue, Providence, US-RI, US, 02905 |
Registration details
| Registration Date | 2013-03-11 |
| Last Update | 2023-08-04 |
| Status | LAPSED |
| Next Renewal | 2021-04-30 |
| LEI Issuer | 5493001KJTIIGC8Y1R12 |
| Corroboration Level | FULLY_CORROBORATED |
| Data Validated As | 000028183 |
| Name | Role | Address |
|---|---|---|
| DIANA M. DUCHARME | Agent | 225 DYER STREET 2ND FLOOR, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| MERRILL R THOMAS | PRESIDENT | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| SUSANA CONKLIN | VP AND CHIEF OF STAFF | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| JAY DECOSTA | VP AND CIO | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| KEVIN CABRAL | VP AND CFO | 375 ALLENS AVE PROVIDENCE, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| CARL BROWN | BOARD CHAIRMAN | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| KIMBERLY O'CONNELL ESQ. | VP AND CHIEF TRANSFORMATION OFFICER | 375 ALLENS AFVENUE PROVIDENCE, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| CHERYL PERRY | VP AND CHIEF HUMAN RESOURCE OFFICER | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| AMBER BICHUM | BOARD - VICE CHAIR | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| MEGHAN HOPKINS ESQ | BOARD - SECRETARY | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| RAFAEL YEPEZ | BOARD - TREASURER | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| NADINE HEWUDALIGE MD | VP AND CHIEF MEDICAL OFFICER | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| CHRISTINA ZANFAGNA | DIRECTOR | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| MICHAEL CANCILLIERE | DIRECTOR | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| RUSSELL CORCORAN MD | DIRECTOR | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| JOSEPH ESPAT MD | DIRECTOR | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| RICHARD HEMPHILL | DIRECTOR | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| CASSANDRA FEENEY ESQ | DIRECTOR | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| EMILLIAN EGBUCHE | DIRECTOR | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| MAYLEM ESTRELLA | DIRECTOR | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| YEISHA MARRERO | DIRECTOR | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| BYRON MONGE | DIRECTOR | 375 ALLENS AVENUE PROVIDENCE, RI 02905 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2013-03-07 | The Providence Community Health Centers | The Providence Community Health Centers, Inc. |
| Name Change | 2011-12-01 | The Providence Community Health Centers, Inc. | The Providence Community Health Centers |
| Merged | 2011-12-01 | Chad Brown Health Center on | The Providence Community Health Centers, Inc. |
| Name Change | 1998-12-09 | Providence Ambulatory Health Care Foundation, Inc. | The Providence Community Health Centers, Inc. |
| Number | Name | File Date |
|---|---|---|
| 202446665700 | Statement of Change of Registered/Resident Agent | 2024-02-16 |
| 202446660660 | Annual Report | 2024-02-16 |
| 202335162880 | Annual Report | 2023-05-02 |
| 202217964740 | Annual Report | 2022-05-30 |
| 202198741130 | Annual Report | 2021-06-28 |
| 202045787290 | Annual Report | 2020-07-21 |
| 201901204940 | Annual Report | 2019-07-03 |
| 201869519490 | Annual Report | 2018-06-13 |
| 201745609020 | Annual Report | 2017-06-16 |
| 201600851580 | Annual Report | 2016-06-20 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
