| Name: | Lifestyle Medicine of Rhode Island, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 18 Dec 2008 (16 years ago) |
| Identification Number: | 000488047 |
| ZIP code: | 02835 |
| County: | Newport County |
| Principal Address: | 530 EAST SHORE ROAD, JAMESTOWN, RI, 02835, USA |
| Mailing Address: | 1524 ATWOOD AVENUE SUITE 336, JOHNSTON, RI, 02919, USA |
| Purpose: | MEDICAL GUIDANCE FOR WEIGHT LOSS |
| Historical names: |
RHODE ISLAND WEIGHTLOSS, LLC |
NAICS
621399 Offices of All Other Miscellaneous Health PractitionersThis U.S. industry comprises establishments of independent health practitioners (except physicians; dentists; chiropractors; optometrists; mental health specialists; physical, occupational, and speech therapists; audiologists; and podiatrists). 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 | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568978690 | 2017-12-27 | 2017-12-27 | 1524 ATWOOD AVE STE 336, JOHNSTON, RI, 029193228, US | 1524 ATWOOD AVE STE 336, JOHNSTON, RI, 029193228, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 401-228-6844 |
| Fax | 4012286855 |
Authorized person
| Name | MRS. MARTHA MARY FONTAINE |
| Role | PRACTICE MANAGER |
| Phone | 4012286844 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | MD04110 |
| State | RI |
| Is Primary | Yes |
| Taxonomy Code | 207QB0002X - Obesity Medicine (Family Medicine) Physician |
| License Number | MD04110 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 2083B0002X - Obesity Medicine (Preventive Medicine) Physician |
| License Number | MD04110 |
| State | RI |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| MARTHA M. FONTAINE | Agent | 1524 ATWOOD AVENUE SUITE 336, JOHNSTON, RI, 02919, USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2017-11-17 | RHODE ISLAND WEIGHTLOSS, LLC | Lifestyle Medicine of Rhode Island, LLC |
| Number | Name | File Date |
|---|---|---|
| 202453266970 | Annual Report | 2024-04-30 |
| 202334667610 | Annual Report | 2023-04-29 |
| 202215559010 | Annual Report | 2022-04-23 |
| 202103842820 | Annual Report | 2021-10-25 |
| 202072224690 | Annual Report | 2020-11-06 |
| 201920374990 | Annual Report | 2019-09-18 |
| 201879879780 | Annual Report | 2018-10-22 |
| 201753543440 | Articles of Amendment | 2017-11-17 |
| 201751941220 | Annual Report | 2017-10-20 |
| 201611317550 | Annual Report | 2016-10-28 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 8123408304 | 2021-01-29 | 0165 | PPS | 1524 Atwood Ave Ste 336, Johnston, RI, 02919-3228 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 13 Oct 2024
Sources: Rhode Island Department of State
