| 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 |
| NAICS: | 621399 - Offices of All Other Miscellaneous Health Practitioners |
| Historical names: |
RHODE ISLAND WEIGHTLOSS, LLC |
| 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 |
Date of last update: 13 Oct 2024
Sources: Rhode Island Department of State
