| 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 (34 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 |
| Fictitious names: |
MEMORIAL GUARDIAN PLAN (trading name, 1991-08-26 - ) |
NAICS
621111 Offices of Physicians (except Mental Health Specialists)This U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of general or specialized medicine (except psychiatry or psychoanalysis) or surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau
| 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 | |||||||||||||||||||||||
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| 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 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 8245747107 | 2020-04-15 | 0165 | PPP | 191 Social Street Suite 840, Woonsocket, RI, 02895 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 08 Apr 2025
Sources: Rhode Island Department of State
