| Name: | SRC PROVIDENCE, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Foreign Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 07 Jan 2016 (9 years ago) |
| Identification Number: | 001659409 |
| Place of Formation: | MASSACHUSETTS |
| Principal Address: | 57 WELLS AVENUE, NEWTON, MA, 02459, USA |
| Purpose: | TO OWN AND/OR OPERATE HEALTHCARE FACILITIES AND TO PROVIDE HEALTHCARE SERVICES AND ANY AND ALL RELATED AND ANCILLARY SERVICES AND TO CARRY ON ANY RELATED LAWFUL BUSINESS, TRADE, PURPOSE OR ACTIVITY AS REQUIRED BY LAW. |
| NAICS: | 623210 - Residential Intellectual and Developmental Disability Facilities |
| Fictitious names: |
Wingate Residences on Blackstone Boulevard (trading name, 2017-06-09 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447615034 | 2015-12-23 | 2015-12-28 | 63 KENDRICK ST, NEEDHAM, MA, 024942708, US | 353 BLACKSTONE BLVD, PROVIDENCE, RI, 029064936, US | |||||||||||||
|
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| Phone | +1 401-273-6565 |
Authorized person
| Name | TAMILYN LEVIN |
| Role | CHIEF FINANCIAL OFFICER |
| Phone | 7817079510 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 450 VETERANS MEMORIAL PARKWAY SUITE 7A, EAST PROVIDENCE, RI, 02914, USA |
| Name | Role | Address |
|---|---|---|
| SCOTT SCHUSTER | Manager | 63 KENDRICK STREET NEEDHAM, MA 02494 USA |
| Number | Name | File Date |
|---|---|---|
| 202447437180 | Annual Report | 2024-02-28 |
| 202329734040 | Annual Report | 2023-03-01 |
| 202221743230 | Annual Report | 2022-07-28 |
| 202218757350 | Revocation Notice For Failure to File An Annual Report | 2022-06-22 |
| 202101215770 | Annual Report | 2021-09-10 |
| 202055682330 | Annual Report | 2020-09-17 |
| 201910782770 | Annual Report | 2019-08-07 |
| 201755134970 | Annual Report | 2018-01-31 |
| 201751156020 | Annual Report | 2017-10-07 |
| 201745110670 | Fictitious Business Name Statement | 2017-06-09 |
Date of last update: 26 Oct 2024
Sources: Rhode Island Department of State
