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  5. Apple Valley Family Treatment Center, Inc.

Apple Valley Family Treatment Center, Inc.

Company Details

Name: Apple Valley Family Treatment Center, Inc.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Dissolved
Date of Organization in Rhode Island: 11 Apr 1988 (37 years ago)
Date of Dissolution: 21 Jun 2018 (7 years ago)
Date of Status Change: 21 Jun 2018 (7 years ago)
Identification Number: 000046576
ZIP code: 02828
County: Providence County
Principal Address: 466 PUTNAM PIKE, GREENVILLE, RI, 02828, USA
Purpose: MEDICAL SERVICES- FAMILY PRACTICE AND AMBULATORY SERVICES
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1043266232 2006-05-26 2020-08-22 466 PUTNAM PIKE, GREENVILLE, RI, 028283002, US 466 PUTNAM PIKE, GREENVILLE, RI, 028283002, US

Contacts
Phone +1 401-949-2010
Fax 4019494140

Authorized person
Name STEPHEN A FANNING
Role MEDICAL DIRECTOR
Phone 4019492010

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
APPLE VALLEY FAMILY TREATMENT CENTER, INC. RETIREMENT PLAN 2014 050437434 2015-12-09 APPLE VALLEY FAMILY TREATMENT CENTER, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621112
Sponsor’s telephone number 4019492010
Plan sponsor’s address 466 PUTNAM PIKE, GREENVILLE, RI, 028283027

Signature of
Role Plan administrator
Date 2015-12-09
Name of individual signing STEPHEN A. FANNING
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-12-09
Name of individual signing STEPHEN A. FANNING
Valid signature Filed with authorized/valid electronic signature
APPLE VALLEY FAMILY TREATMENT CENTER, INC. RETIREMENT PLAN 2014 050437434 2015-06-10 APPLE VALLEY FAMILY TREATMENT CENTER, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621112
Sponsor’s telephone number 4019492010
Plan sponsor’s address 466 PUTNAM PIKE, GREENVILLE, RI, 028283027

Signature of
Role Plan administrator
Date 2015-06-10
Name of individual signing STEPHEN FANNING
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-10
Name of individual signing STEPHEN FANNING
Valid signature Filed with authorized/valid electronic signature
APPLE VALLEY FAMILY TREATMENT CENTER, INC. RETIREMENT PLAN 2013 050437434 2014-08-13 APPLE VALLEY FAMILY TREATMENT CENTER, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621112
Sponsor’s telephone number 4019492010
Plan sponsor’s address 466 PUTNAM PIKE, GREENVILLE, RI, 028283027

Signature of
Role Plan administrator
Date 2014-08-13
Name of individual signing STEPHEN FANNING
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-08-13
Name of individual signing STEPHEN FANNING
Valid signature Filed with authorized/valid electronic signature
APPLE VALLEY FAMILY TREATMENT CENTER, INC. RETIREMENT PLAN 2012 050437434 2013-09-18 APPLE VALLEY FAMILY TREATMENT CENTER, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621112
Sponsor’s telephone number 4019492010
Plan sponsor’s address 466 PUTNAM PIKE, GREENVILLE, RI, 028283027

Signature of
Role Plan administrator
Date 2013-09-18
Name of individual signing STEPHEN FANNING
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-09-18
Name of individual signing STEPHEN FANNING
Valid signature Filed with authorized/valid electronic signature
APPLE VALLEY FAMILY TREATMENT CENTER, INC. RETIREMENT PLAN 2011 050437434 2012-09-06 APPLE VALLEY FAMILY TREATMENT CENTER, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621112
Sponsor’s telephone number 4019492010
Plan sponsor’s address 466 PUTNAM PIKE, GREENVILLE, RI, 028283027

Plan administrator’s name and address
Administrator’s EIN 050437434
Plan administrator’s name APPLE VALLEY FAMILY TREATMENT CENTER, INC.
Plan administrator’s address 466 PUTNAM PIKE, GREENVILLE, RI, 028283027
Administrator’s telephone number 4019492010

Signature of
Role Plan administrator
Date 2012-09-06
Name of individual signing STEPHEN FANNING
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-09-06
Name of individual signing STEPHEN FANNING
Valid signature Filed with authorized/valid electronic signature
APPLE VALLEY FAMILY TREATMENT CENTER, INC. RETIREMENT PLAN 2010 050437434 2011-09-08 APPLE VALLEY FAMILY TREATMENT CENTER, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621112
Sponsor’s telephone number 4019492010
Plan sponsor’s address 466 PUTNAM PIKE, GREENVILLE, RI, 028283027

Plan administrator’s name and address
Administrator’s EIN 050437434
Plan administrator’s name APPLE VALLEY FAMILY TREATMENT CENTER, INC.
Plan administrator’s address 466 PUTNAM PIKE, GREENVILLE, RI, 028283027
Administrator’s telephone number 4019492010

Signature of
Role Plan administrator
Date 2011-09-08
Name of individual signing STEPHEN FANNING
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-09-08
Name of individual signing STEPHEN FANNING
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SUSAN B. FANNING Agent 34 SASSAFRAS ROAD, NORTH KINGSTOWN, RI, 02852, USA

PRESIDENT

Name Role Address
SUSAN B. FANNING PRESIDENT 34 SASSAFRAS ROAD NORTH KINGSTOWN, RI 02852 USA

Filings

Number Name File Date
201870176680 Articles of Dissolution 2018-06-21
201870176220 Annual Report 2018-06-21
201870176590 Annual Report 2018-06-21
201870175700 Reinstatement 2018-06-21
201752749050 Revocation Certificate For Failure to File the Annual Report for the Year 2017-11-02
201747709520 Revocation Notice For Failure to File An Annual Report 2017-07-27
201694070250 Annual Report 2016-03-09
201554445060 Annual Report 2015-01-30
201435559790 Annual Report 2014-02-12
201311764780 Annual Report 2013-02-15

Related by officers

SUSAN B. FANNING

466 PUTNAM PLAZA LLC

Related by address

466 PUTNAM PIKE, GREENVILLE, RI, 02828, USA

M.W. Associates, Inc. 466 PUTNAM PLAZA LLC

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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