| Name: | Blackstone Valley Center for Internal Medicine,Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 13 Sep 1991 (33 years ago) |
| Identification Number: | 000065503 |
| ZIP code: | 02895 |
| County: | Providence County |
| Principal Address: | 191 SOCIAL STREET SUITE 840, WOONSOCKET, RI, 02895, USA |
| Purpose: | PROFESSIONAL CORPORATION ENGAGED IN THE PRACTICE OF MEDICINE |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| Fictitious names: |
MEMORIAL GUARDIAN PLAN (trading name, 1991-08-26 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326188095 | 2007-02-08 | 2012-10-16 | 5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA, 921211705, US | 191 SOCIAL ST, SUITE 840, WOONSOCKET, RI, 028953240, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 858-625-2990 |
| Fax | 8586252999 |
| Phone | +1 401-762-2535 |
| Fax | 4017622858 |
Authorized person
| Name | MR. KENNY HEINE |
| Role | DIRECTOR OF OPERATIONS |
| Phone | 8586252990 |
Taxonomy
| Taxonomy Code | 332900000X - Non-Pharmacy Dispensing Site |
| License Number | MD07911 |
| State | RI |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ADLER POLLOCK & SHEEHAN P.C. | Agent | ONE CITIZENS PLAZA 8TH FLOOR, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| GREIGSTONE YEARWOOD MD | PRESIDENT | 160 ROCCO AVENUE PAWTUCKET, RI 02860 USA |
| Name | Role | Address |
|---|---|---|
| ESTHER O YEARWOOD | OFFICE MANAGER | 160 ROCCO AVENUE PAWTUCKET, RI 02895 USA |
| Number | Name | File Date |
|---|---|---|
| 202454533620 | Annual Report | 2024-05-18 |
| 202336633550 | Annual Report | 2023-06-06 |
| 202216788130 | Annual Report | 2022-05-03 |
| 202188427910 | Annual Report | 2021-01-30 |
| 202034263220 | Annual Report | 2020-02-12 |
| 201984693620 | Annual Report | 2019-02-22 |
| 201857771190 | Annual Report | 2018-02-07 |
| 201729798140 | Annual Report | 2017-01-10 |
| 201690465780 | Annual Report | 2016-01-13 |
| 201452404420 | Annual Report | 2014-12-23 |
Date of last update: 07 Oct 2024
Sources: Rhode Island Department of State
