| Name: | Latin Adult Day Health Care Center: Home Care Services, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 20 Mar 2018 (7 years ago) |
| Date of Dissolution: | 29 Dec 2020 (4 years ago) |
| Date of Status Change: | 29 Dec 2020 (4 years ago) |
| Identification Number: | 001682461 |
| ZIP code: | 02904 |
| County: | Providence County |
| Principal Address: | 665 CHARLES STREET, PROVIDENCE, RI, 02904, USA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720575426 | 2018-04-18 | 2018-07-02 | 665 CHARLES STREET, PROVIDENCE, RI, 02904, US | 665 CHARLES STREET, PROVIDENCE, RI, 02904, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 401-288-8672 |
| Fax | 4016030912 |
Authorized person
| Name | MARIO MANCEBO |
| Role | OWNER |
| Phone | 4012888672 |
Taxonomy
| Taxonomy Code | 376J00000X - Homemaker |
| License Number | HCP02470 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1013308188 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| MARIO MANCEBO | Agent | 665 CHARLES STREET, PROVIDENCE, RI, 02904, USA |
| Number | Name | File Date |
|---|---|---|
| 202082588960 | Revocation Certificate For Failure to File the Annual Report for the Year | 2020-12-29 |
| 202045507870 | Revocation Notice For Failure to File An Annual Report | 2020-07-20 |
| 201860297900 | Articles of Organization | 2018-03-20 |
Date of last update: 27 Oct 2024
Sources: Rhode Island Department of State
