| Name: | INDEPENDENCE, INC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 13 Jun 1986 (39 years ago) |
| Date of Dissolution: | 21 Sep 1989 (35 years ago) |
| Date of Status Change: | 21 Sep 1989 (35 years ago) |
| Identification Number: | 000039079 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336202811 | 2006-12-18 | 2022-12-07 | 2224 PAWTUCKET AVE UNIT 3, EAST PROVIDENCE, RI, 029141716, US | 2224 PAWTUCKET AVE UNIT 3, EAST PROVIDENCE, RI, 029141716, US | |||||||||||||||||||||
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| Phone | +1 401-273-8888 |
| Fax | 4012739986 |
Authorized person
| Name | TODD ACKERMAN |
| Role | PRESIDENT |
| Phone | 4012738888 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1440001 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| DANIEL W. ANDERSON | Agent | 138 BELLMAN AVENUE, WARWICK, RI, 02889, USA |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
