| Name: | Discovery House Utah, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Foreign Corporation |
| Status: | Withdrawn |
| Date of Organization in Rhode Island: | 13 Feb 2002 (23 years ago) |
| Date of Dissolution: | 29 Jul 2013 (12 years ago) |
| Date of Status Change: | 29 Jul 2013 (12 years ago) |
| Identification Number: | 000122915 |
| ZIP code: | 02905 |
| County: | Providence County |
| Place of Formation: | UTAH |
| Principal Address: | 449 EAST 2100 SOUTH, SALT LAKE CITY, UT, 84115, USA |
| Mailing Address: | 66 PAVILION AVENUE, PROVIDENCE, RI, 02905, USA |
| Purpose: | OUT-PATIENT SUBSTANCE ABUSE TREATMENT AND ANY OTHER LAWFUL PURPOSE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417955733 | 2005-07-11 | 2020-08-22 | 66 PAVILION AVE, PROVIDENCE, RI, 029051522, US | 88 W WARWICK AVE, WEST WARWICK, RI, 028933871, US | |||||||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 401-780-2300 |
| Phone | +1 401-821-8866 |
| Fax | 4018211319 |
Authorized person
| Name | PETER MORRIS |
| Role | VICE PRESIDENT OF FINANCE |
| Phone | 4017802300 |
Taxonomy
| Taxonomy Code | 261QR0405X - Substance Use Disorder Rehabilitation Clinic/Center |
| License Number | 608.3 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BEACON HEALTH STRATEGIES |
| Number | 1029400 |
| State | RI |
| Issuer | UNITED RITECARE |
| Number | 8481061 |
| State | RI |
| Issuer | BLUECHIP RITECARE |
| Number | 410268 |
| State | RI |
| Issuer | MEDICAID |
| Number | DH42856 |
| State | RI |
| Issuer | UNITED HEALTHCARE |
| Number | 8410032 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| DAVID L. PICCOLI, II | Agent | 66 PAVILION AVENUE, PROVIDENCE, RI, 02905-, USA |
| Name | Role | Address |
|---|---|---|
| DAVID L PICCOLI II | PRESIDENT | 66 PAVILION AVENUE PROVIDENCE, RI 02905- USA |
| Number | Name | File Date |
|---|---|---|
| 201326291350 | Annual Report | 2013-07-29 |
| 201326291530 | Application for Certificate of Withdrawal | 2013-07-29 |
| 201321887080 | Revocation Notice For Failure to File An Annual Report | 2013-06-03 |
| 201288122330 | Annual Report | 2012-01-17 |
| 201175558370 | Annual Report | 2011-02-23 |
| 201057980770 | Annual Report | 2010-02-03 |
| 200941569400 | Annual Report | 2009-01-29 |
| 200939893870 | Annual Report | 2009-01-05 |
| 200809854330 | Annual Report | 2008-03-19 |
| 200805092420 | Annual Report | 2008-01-03 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
