| Name: | Providence Fertility Institute, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 01 Aug 2012 (12 years ago) |
| Date of Dissolution: | 12 Oct 2022 (2 years ago) |
| Date of Status Change: | 12 Oct 2022 (2 years ago) |
| Identification Number: | 000792123 |
| ZIP code: | 02920 |
| County: | Providence County |
| Principal Address: | 1150 RESERVOIR AVENUE SUITE 300, CRANSTON, RI, 02920, USA |
| Purpose: | GYNECOLOGY, REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY Title: 7-1.2 |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| Fictitious names: |
Providence Fertility Center (trading name, 2012-08-09 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528479227 | 2014-05-15 | 2019-01-15 | 1150 RESERVOIR AVE STE 300, CRANSTON, RI, 029206043, US | 1150 RESERVOIR AVE STE 300, CRANSTON, RI, 029206043, US | |||||||||||||||||||
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| Phone | +1 401-366-6027 |
| Fax | 4013666079 |
Authorized person
| Name | ANN WOLD |
| Role | OWNER |
| Phone | 4012722562 |
Taxonomy
| Taxonomy Code | 207VE0102X - Reproductive Endocrinology Physician |
| Is Primary | No |
| Taxonomy Code | 207VG0400X - Gynecology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| TAMMY A. BOTTELLA, ESQ. | Agent | 255 QUAKER LANE SUITE 600, WEST WARWICK, RI, 02893, USA |
| Name | Role | Address |
|---|---|---|
| ANNE DEVI WOLD | PRESIDENT | 1150 RESERVOIR AVENUE, SUITE 300 CRANSTON , RI 02920 USA |
| Number | Name | File Date |
|---|---|---|
| 202223923630 | Revocation Certificate For Failure to File the Annual Report for the Year | 2022-10-12 |
| 202220136420 | Revocation Notice For Failure to File An Annual Report | 2022-06-27 |
| 202197922990 | Annual Report | 2021-06-08 |
| 202196891260 | Revocation Notice For Failure to File An Annual Report | 2021-05-19 |
| 202036574270 | Annual Report | 2020-03-19 |
| 201983890390 | Annual Report | 2019-01-07 |
| 201983890750 | Annual Report | 2019-01-07 |
| 201983891090 | Annual Report | 2019-01-07 |
| 201983891270 | Annual Report | 2019-01-07 |
| 201983891540 | Annual Report | 2019-01-07 |
Date of last update: 17 Oct 2024
Sources: Rhode Island Department of State
