| Name: | Chad Brown Health Center |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Non-Profit Corporation |
| Status: | Merged Into An Entity Of Record |
| Date of Organization in Rhode Island: | 13 Nov 1990 (34 years ago) |
| Date of Dissolution: | 01 Dec 2011 (13 years ago) |
| Date of Status Change: | 01 Dec 2011 (13 years ago) |
| Identification Number: | 000062432 |
| ZIP code: | 02908 |
| County: | Providence County |
| Principal Address: | 285A CHAD BROWN STREET, PROVIDENCE, RI, 02908, USA |
| Purpose: | COMMUNITY HEALTH CARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053443911 | 2007-03-09 | 2020-08-22 | 10 ORMS ST STE 110, PROVIDENCE, RI, 029047814, US | 285A CHAD BROWN ST, PROVIDENCE, RI, 029083102, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 401-453-0666 |
| Fax | 4014539619 |
| Phone | +1 401-274-6339 |
| Fax | 4014536290 |
Authorized person
| Name | NANCY CLANCY |
| Role | FINANCE |
| Phone | 4012746339 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | GROUP BS NUMBER |
| Number | 451-2 |
| State | RI |
| Issuer | MEDICAID |
| Number | 9000451 |
| State | RI |
| Issuer | NEIBORHOOD HEALTH GROUP |
| Number | 0181 |
| State | RI |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHAD BROWN HEALTH CENTER 401 K PROFIT SHARING PLAN TRUST | 2010 | 050391357 | 2011-06-22 | CHAD BROWN HEALTH CENTER | 14 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 050391357 |
| Plan administrator’s name | CHAD BROWN HEALTH CENTER |
| Plan administrator’s address | 285 A CHAD BROWN ST, PROVIDENCE, RI, 02908 |
| Administrator’s telephone number | 4012746339 |
Signature of
| Role | Plan administrator |
| Date | 2011-06-22 |
| Name of individual signing | CHAD BROWN HEALTH CENTER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| RICHARD PERREAULT | Agent | 285A CHAD BROWN STREET, PROVIDENCE, RI, 02908, USA |
| Name | Role | Address |
|---|---|---|
| RICHARD PERREAULT | PRESIDENT | 211 WOODRIDGE DRIVE SAUNDERSTOWN, RI 02874- USA |
| Name | Role | Address |
|---|---|---|
| ELVYS RUIZ | DIRECTOR | 52 BISMARK STREET PROVIDENCE, RI 02904 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Merged | 2011-12-01 | Chad Brown Health Center | The Providence Community Health Centers, Inc. on |
| Number | Name | File Date |
|---|---|---|
| 201183438770 | Annual Report | 2011-09-26 |
| 201066437650 | Annual Report | 2010-07-30 |
| 200948012800 | Annual Report | 2009-07-07 |
| 200812039920 | Annual Report | 2008-06-17 |
Date of last update: 07 Oct 2024
Sources: Rhode Island Department of State
