| Name: | VICTA, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 01 Sep 2017 (8 years ago) |
| Identification Number: | 001676874 |
| ZIP code: | 02907 |
| County: | Providence County |
| Principal Address: | 110 ELMWOOD AVENUE, PROVIDENCE, RI, 02907, USA |
| Purpose: | MENTAL HEALTH CLINIC |
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 | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457822413 | 2018-12-16 | 2019-02-21 | 110 ELMWOOD AVE, PROVIDENCE, RI, 029072423, US | 110 ELMWOOD AVE, PROVIDENCE, RI, 029072423, US | |||||||||||||||||||||
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| Phone | +1 401-300-5757 |
| Fax | 4013005656 |
Authorized person
| Name | MR. ALEXANDER DONOYAN |
| Role | CEO |
| Phone | 4013005757 |
Taxonomy
| Taxonomy Code | 261QM2800X - Methadone Clinic |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1104317007 |
| State | RI |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| VICTA LLC 401 K PROFIT SHARING PLAN TRUST | 2018 | 822674235 | 2019-05-29 | VICTA LLC | 0 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 264477125 |
| Plan administrator’s name | 401K GENERATION |
| Plan administrator’s address | 195 INTERNATIONAL PKWY, S #311, LAKE MARY, FL, 32746 |
| Administrator’s telephone number | 8669985879 |
Signature of
| Role | Plan administrator |
| Date | 2019-05-29 |
| Name of individual signing | EDWARD ROJAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| RYAN J. LUTRARIO | Agent | 564 S. WATER STREET, PROVIDENCE, RI, 02903, USA |
| Number | Name | File Date |
|---|---|---|
| 202455248910 | Statement of Change of Registered/Resident Agent Office | 2024-06-03 |
| 202448534220 | Annual Report | 2024-03-14 |
| 202338542490 | Annual Report - Amended | 2023-06-21 |
| 202331229280 | Annual Report | 2023-03-21 |
| 202216008760 | Annual Report | 2022-04-28 |
| 202104145470 | Annual Report | 2021-10-28 |
| 202069725580 | Annual Report | 2020-10-29 |
| 201927448900 | Annual Report | 2019-11-14 |
| 201993219260 | Statement of Change of Registered/Resident Agent | 2019-05-15 |
| 201883335180 | Annual Report | 2018-12-28 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1777647405 | 2020-05-04 | 0165 | PPP | 110 ELMWOOD AVE, PROVIDENCE, RI, 02907-2423 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 27 Oct 2024
Sources: Rhode Island Department of State
