| Name: | Life Care at Home of Rhode Island, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Foreign Corporation |
| Status: | Withdrawn |
| Date of Organization in Rhode Island: | 14 Aug 2002 (23 years ago) |
| Date of Dissolution: | 28 Sep 2018 (6 years ago) |
| Date of Status Change: | 28 Sep 2018 (6 years ago) |
| Identification Number: | 000126483 |
| Place of Formation: | TENNESSEE |
| Principal Address: | 3570 KEITH STREET NW, CLEVELAND, TN, 37312, USA |
| Mailing Address: | 3570 KEITHER STREET NW, CLEVELAND, TN, 37312, USA |
| Purpose: | OWN, OPERATE AND/OR MANAGE HEALTHCARE FACILITY |
| NAICS: | 621610 - Home Health Care Services |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346243490 | 2005-05-23 | 2011-03-30 | 3001 KEITH ST NW, CLEVELAND, TN, 373123713, US | 63 SOCKANOSSET CROSS RD, STE 1C, CRANSTON, RI, 029205557, US | |||||||||||||||||||||||||||||||||||
|
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| Phone | +1 423-473-5256 |
| Fax | 4233398356 |
| Phone | +1 508-238-6878 |
| Fax | 5082386980 |
Authorized person
| Name | PAMELA RAU |
| Role | VP OF FINANCE |
| Phone | 4234735280 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | 02286 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUECROSS BLUE SHIELD |
| Number | 58748 |
| State | RI |
| Issuer | BLUE CHIP PROVIDER |
| Number | 409746 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY | Agent | 222 JEFFERSON BOULEVARD SUITE 200, WARWICK, RI, 02888, USA |
| Name | Role | Address |
|---|---|---|
| FORREST L. PRESTON | PRESIDENT | 3570 KEITH STREET, NW CLEVELAND, TN 37312 USA |
| Name | Role | Address |
|---|---|---|
| STEPHEN ZIEGLER | TREASURER | 3570 KEITH STREET, NW CLEVELAND, TN 37312 |
| Name | Role | Address |
|---|---|---|
| JOAN E. THURMOND | ASSISTANT SECRETARY | 3570 KEITH STREET, NE CLEVELAND, TN 37312 USA |
| Number | Name | File Date |
|---|---|---|
| 201878456270 | Application for Certificate of Withdrawal | 2018-09-28 |
| 201878026040 | Annual Report | 2018-09-24 |
| 201875498020 | Revocation Notice For Failure to File An Annual Report | 2018-08-24 |
| 201737857350 | Annual Report | 2017-03-10 |
| 201694677620 | Annual Report | 2016-03-14 |
| 201561887770 | Annual Report | 2015-05-21 |
| 201434941370 | Annual Report | 2014-02-03 |
| 201310606810 | Annual Report | 2013-01-31 |
| 201291194340 | Statement of Change of Registered/Resident Agent | 2012-03-19 |
| 201288630330 | Annual Report | 2012-01-30 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
