| Name: | South County Wellness Group, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 31 Dec 2003 (21 years ago) |
| Date of Dissolution: | 23 Sep 2009 (15 years ago) |
| Date of Status Change: | 23 Sep 2009 (15 years ago) |
| Identification Number: | 000136975 |
| ZIP code: | 02852 |
| County: | Washington County |
| Principal Address: | 1130 TEN ROD ROAD MEADOWS E SUITE 302, NORTH KINGSTOWN, RI, 02852, USA |
| Mailing Address: | 1130 TEN ROD ROAD MEADOWS SUITE E-302, NORTH KINGSTOWN, RI, 02852, USA |
| Purpose: | A PRIVATE PRACTICE PROVIDING PSYCHIATRIC MEDICATION, MONITORING, THERAPY AND PSYCHIATRIC EVALUATIONS |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861555690 | 2006-12-19 | 2020-08-22 | 1130 TEN ROD RD, SUITE E302, NORTH KINGSTOWN, RI, 028524161, US | 1130 TEN ROD RD, SUITE E302, NORTH KINGSTOWN, RI, 028524161, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 401-667-7079 |
Authorized person
| Name | MRS. CATHY L KENNEDY |
| Role | PRESCRIPTIVE CLINICAL NURSE SPECIAL |
| Phone | 4016677079 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| License Number | PPNS00010 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| License Number | PPNS00047 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1962597336 |
| State | RI |
| Issuer | NPI |
| Number | 1043260268 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| CATHY L. KENNEDY, MSN, RNCS | Agent | 1130 TEN ROD ROAD SUITE E 302, NORTH KINGSTOWN, RI, 02852, USA |
| Number | Name | File Date |
|---|---|---|
| 200951646180 | Articles of Dissolution | 2009-09-23 |
| 200835639220 | Annual Report | 2008-09-30 |
| 200701839570 | Annual Report | 2007-10-01 |
| 200700791590 | Statement of Change of Registered/Resident Agent Office | 2007-09-25 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
