| Name: | Butler Hospital |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Non-Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 02 Jan 1844 (181 years ago) |
| Identification Number: | 000034675 |
| ZIP code: | 02906 |
| County: | Providence County |
| Principal Address: | 345 BLACKSTONE BOULEVARD, PROVIDENCE, RI, 02906, USA |
| Purpose: | NON-PROFIT HOSPITAL AND ASSOCIATED FACILITIES FOR THE DIAGNOSIS CARE AND TREATMENT OF PERSONS SUFFERING FROM MENTAL ILLNESS SUBSTANCE ABUSE AND OTHER BEHAVIORAL AND NEUROBEHAVIORAL DISORDERS. JANUARY SESSION 1844 |
| NAICS: | 622210 - Psychiatric and Substance Abuse Hospitals |
| Fictitious names: |
Behavioral Health Specialists, Inc. (trading name, 1997-09-24 - ) |
| Historical names: |
The Rhode Island Asylum for the Insane Butler Hospital for the Insane Butler Hospital Butler Health Center |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104801349 | 2005-12-09 | 2023-10-06 | 345 BLACKSTONE BLVD, PROVIDENCE, RI, 029064800, US | 345 BLACKSTONE BLVD, PROVIDENCE, RI, 029064800, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 401-455-6200 |
| Fax | 4014556498 |
Authorized person
| Name | MR. STEPHEN E BURKE |
| Role | VP OF FINANCE |
| Phone | 4014556275 |
Taxonomy
| Taxonomy Code | 276400000X - Substance Use Disorder Rehabilitation Hospital Unit |
| Is Primary | No |
| Taxonomy Code | 283Q00000X - Psychiatric Hospital |
| License Number | HOS00124 |
| State | RI |
| Is Primary | Yes |
| Taxonomy Code | 324500000X - Substance Abuse Rehabilitation Facility |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4104000 |
| State | RI |
| Issuer | SUB PART |
| Number | 1093831646 |
| State | RI |
| LEI number | Registered As | Jurisdiction Of Formation | General Category | Entity Status | Entity created at | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 549300W18OGMT5LGDC55 | 000034675 | US-RI | GENERAL | ACTIVE | No data | |||||||||||||||||||
|
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| Legal | C/O Patricia R. Recupero, 345 Blackstone Boulevard, Providence, US-RI, US, 02906 |
| Headquarters | C/O Patricia R. Recupero, 345 Blackstone Boulevard, Providence, US-RI, US, 02906 |
Registration details
| Registration Date | 2013-08-22 |
| Last Update | 2023-08-04 |
| Status | LAPSED |
| Next Renewal | 2014-08-22 |
| LEI Issuer | 5493001KJTIIGC8Y1R12 |
| Corroboration Level | FULLY_CORROBORATED |
| Data Validated As | 000034675 |
| Name | Role | Address |
|---|---|---|
| MARYANN DASILVA | Agent | 345 BLACKSTONE BOULEVARD, PROVIDENCE, RI, 02906, USA |
| Name | Role | Address |
|---|---|---|
| MARY MARRAN | PRESIDENT | 345 BLACKSTONE BOULEVARD PROVIDENCE, RI 02906 USA |
| Name | Role | Address |
|---|---|---|
| JAMES BOTVIN | SECRETARY | 12 BAGY WRINKLE COVE WARREN, RI 02885 USA |
| Name | Role | Address |
|---|---|---|
| GARY FURTADO | CHAIRPERSON | 15 BETH AVENUE WARREN, RI 02885 USA |
| Name | Role | Address |
|---|---|---|
| R. STEPHEN MANTY | VICE CHAIRPERSON | 110 ROYAL LITTLE DRIVE PROVIDENCE, RI 02904 USA |
| Name | Role | Address |
|---|---|---|
| ASHLEY TAYLOR | ASSISTANT SECRETARY | 4 RICHMOND SQUARE PROVIDENCE, RI 02906 USA |
| Name | Role | Address |
|---|---|---|
| JOSEPH J. MCGAIR ESQ. | DIRECTOR | 92 SANDY LANE WARWICK, RI 02889 USA |
| JUDITH REMONDI | DIRECTOR | 258 BRIDLE TRAIL ROAD NEEDHAM, MA 02492 USA |
| PETER R. PHILLIPS | DIRECTOR | 156 WESTMINSTER STREET PROVIDENCE, RI 02903 USA |
| CAROLYNN MASTERS PH.D., RN | DIRECTOR | RHODE ISLAND COLLEGE, FLS 158-600 MOUNT PLEASANT AVENUE PROVIDENCE, RI 02906 USA |
| CHARLES R. REPUCCI | DIRECTOR | 215 SUNNYBROOK FARM ROAD NARRAGANSETT, RI 02882 USA |
| R. STEPHEN MANTY | DIRECTOR | 110 ROYAL LITTLE DRIVE PROVIDENCE, RI 02904 USA |
| KEVIN BAILL MD | DIRECTOR | 345 BLACKSTONE BLVD PROVIDENCE, RI 02906 USA |
| ANA TUYA FULTON MD | DIRECTOR | 4 RICHMOND SQUARE PROVIDENCE, RI 02906 USA |
| GARY FURTADO | DIRECTOR | 15 BETH AVENUE WARREN, RI 02885 USA |
| PATRICK MURRAY | DIRECTOR | 255 BOXWOOD LANE BRIDGEWATER, MA 02324 USA |
| Name | Role | Address |
|---|---|---|
| TODD CONKLIN | ASSISTANT TREASURER | 4 RICHMOND SQUARE PROVIDENCE, RI 02906 USA |
| Name | Role | Address |
|---|---|---|
| R. STEPHEN MANTY | TREASURER | 110 ROYAL LITTLE DRIV PROVIDENCE, RI 02904 USA |
| Name | Role | Address |
|---|---|---|
| MICHAEL WAGNER MD | EX OFFICIO DIRECTOR | 4 RICHMOND SQUARE PROVIDENCE, RI 02906 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 1962-05-02 | Butler Health Center | Butler Hospital |
| Name Change | 1957-03-12 | Butler Hospital | Butler Health Center |
| Name Change | 1906-01-02 | Butler Hospital for the Insane | Butler Hospital |
| Name Change | 1844-10-01 | The Rhode Island Asylum for the Insane | Butler Hospital for the Insane |
| Number | Name | File Date |
|---|---|---|
| 202448374970 | Annual Report | 2024-03-12 |
| 202329095240 | Annual Report | 2023-02-22 |
| 202215325020 | Annual Report - Amended | 2022-04-21 |
| 202213262200 | Annual Report | 2022-03-22 |
| 202198176130 | Annual Report | 2021-06-11 |
| 202078439700 | Annual Report | 2020-12-03 |
| 201995469870 | Annual Report | 2019-06-05 |
| 201868036600 | Annual Report | 2018-06-01 |
| 201746810560 | Annual Report | 2017-06-29 |
| 201749709690 | Annual Report | 2017-06-28 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
