| Name: | BAXTER BEHAVIORAL HEALTH, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 20 Mar 2015 (10 years ago) |
| Identification Number: | 001095466 |
| ZIP code: | 02852 |
| County: | Washington County |
| Principal Address: | P.O. BOX 949, NORTH KINGSTOWN, RI, 02852, USA |
| Mailing Address: | PO BOX 949, NORTH KINGSTOWN, RI, 02852, USA |
| Purpose: | TO ENGAGE IN ANY LAWFUL BUSINESS |
NAICS
621330 Offices of Mental Health Practitioners (except Physicians)This industry comprises establishments of independent mental health practitioners (except physicians) primarily engaged in (1) the diagnosis and treatment of mental, emotional, and behavioral disorders and/or (2) the diagnosis and treatment of individual or group social dysfunction brought about by such causes as mental illness, alcohol and substance abuse, physical and emotional trauma, or stress. 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 | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972975845 | 2015-10-30 | 2024-06-05 | PO BOX 949, NORTH KINGSTOWN, RI, 028520610, US | 1130 TEN ROD RD STE D101, NORTH KINGSTOWN, RI, 028524161, US | |||||||||||||||||||||||||
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| Phone | +1 401-267-4485 |
| Fax | 4012674534 |
Authorized person
| Name | RYAN PATRICK BAXTER |
| Role | OWNER |
| Phone | 4012674485 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| License Number | NPP37892 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1972975485 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| BRUCE A. WOLPERT, ESQ. | Agent | 235 PROMENADE STREET SUITE 475, PROVIDENCE, RI, 02908, USA |
| Number | Name | File Date |
|---|---|---|
| 202448561910 | Annual Report | 2024-03-12 |
| 202330765400 | Annual Report | 2023-03-11 |
| 202222500030 | Statement of Change of Registered/Resident Agent Office | 2022-08-26 |
| 202212469060 | Annual Report | 2022-03-07 |
| 202102206470 | Annual Report | 2021-09-27 |
| 202062951210 | Annual Report | 2020-10-06 |
| 201918755820 | Annual Report | 2019-09-09 |
| 201877718180 | Annual Report | 2018-09-17 |
| 201752191480 | Annual Report | 2017-10-23 |
| 201610227120 | Annual Report | 2016-10-11 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 2703807200 | 2020-04-16 | 0165 | PPP | 1130 ten rod road Building D suite 102, North Kingstown, RI, 02852 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 20 Oct 2024
Sources: Rhode Island Department of State
