| Name: | VICTA, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 01 Sep 2017 (7 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) |
| 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 |
Date of last update: 27 Oct 2024
Sources: Rhode Island Department of State
