| Name: | Cranston East Medical Clinic, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 30 Apr 2009 (16 years ago) |
| Date of Dissolution: | 22 Apr 2013 (12 years ago) |
| Date of Status Change: | 22 Apr 2013 (12 years ago) |
| Identification Number: | 000506512 |
| ZIP code: | 02920 |
| County: | Providence County |
| Principal Address: | 934 PARK AVENUE, CRANSTON, RI, 02920, USA |
| Mailing Address: | 402 WOODHAVEN COURT, CRANSTON, RI, 02920, USA |
| Purpose: | MEDICAL OFFICE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396977823 | 2009-08-17 | 2009-08-17 | 934 PARK AVE, CRANSTON, RI, 029102708, US | 934 PARK AVE, CRANSTON, RI, 029102708, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 401-941-3166 |
| Fax | 4019413122 |
Authorized person
| Name | DR. WILLIAM C CHANG |
| Role | MEDICAL DIRECTOR |
| Phone | 4019413166 |
Taxonomy
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| License Number | 6631 |
| State | RI |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WILLIAM CHANG | Agent | 402 WOODHAVEN COURT, CRANSTON, RI, 02920, USA |
| Number | Name | File Date |
|---|---|---|
| 201315504940 | Revocation Certificate For Failure to File the Annual Report for the Year | 2013-04-22 |
| 201308133870 | Revocation Notice For Failure to File An Annual Report | 2013-01-09 |
| 201183198340 | Annual Report | 2011-09-19 |
| 201178962390 | Annual Report | 2011-05-16 |
| 201177529170 | Revocation Notice For Failure to File An Annual Report | 2011-04-04 |
| 200945402730 | Articles of Organization | 2009-04-30 |
Date of last update: 14 Oct 2024
Sources: Rhode Island Department of State
