| Name: | PERSONAL HOME HEALTH SERVICES, INC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 10 May 1985 (40 years ago) |
| Date of Dissolution: | 20 Oct 2008 (16 years ago) |
| Date of Status Change: | 20 Oct 2008 (16 years ago) |
| Identification Number: | 000034438 |
| ZIP code: | 02864 |
| County: | Providence County |
| Principal Address: | 10 NATE WHIPPLE HIGHWAY, CUMBERLAND, RI, 02864, USA |
| Purpose: | CARE OF INDIVIDUALS IN NEED OF SUPPORT, AID AND ASSISTANCE IN DEPENDENT SETTING FOR MEDICAL PHYSIOLOGICAL |
| Historical names: |
PERSONAL & HOME CARE SERVICES, INC. |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962400929 | 2005-07-13 | 2020-08-22 | 10 NATE WHIPPLE HWY, STE 9, CUMBERLAND, RI, 028641415, US | 10 NATE WHIPPLE HWY, STE 9, CUMBERLAND, RI, 028641415, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 401-658-1383 |
| Fax | 4016580384 |
Authorized person
| Name | SUZANNE MARCOUX |
| Role | PRESIDENT |
| Phone | 4016581383 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | HCP02419 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PH16333 |
| State | RI |
| Issuer | MEDICAID |
| Number | PH18712 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| JONATHAN F. OSTER | Agent | 1525 OLD LOUISQUISSET PIKE SUITE C203, LINCOLN, RI, 02865, USA |
| Name | Role | Address |
|---|---|---|
| SUZANNE MARCOUX | PRESIDENT | 10 NATE WHIPPLE HIGHWAY CUMBERLAND, RI 02864 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 1991-07-17 | PERSONAL & HOME CARE SERVICES, INC. | PERSONAL HOME HEALTH SERVICES, INC. |
| Number | Name | File Date |
|---|---|---|
| 200836537480 | Revocation Certificate For Failure to File the Annual Report for the Year | 2008-10-20 |
| 200812802920 | Revocation Notice For Failure to File An Annual Report | 2008-08-04 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
