| Name: | Phoenix Health Professional Group, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 03 Jun 2020 (5 years ago) |
| Date of Dissolution: | 14 Feb 2022 (3 years ago) |
| Date of Status Change: | 14 Feb 2022 (3 years ago) |
| Identification Number: | 001708375 |
| ZIP code: | 02906 |
| County: | Providence County |
| Principal Address: | 99 WAYLAND AVENUE SUITE #100, PROVIDENCE, RI, 02906, USA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063037364 | 2020-06-11 | 2020-06-11 | 1301 ATWOOD AVE STE 100, JOHNSTON, RI, 029194933, US | 99 WAYLAND AVE STE 100, PROVIDENCE, RI, 029064314, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 617-771-1154 |
Authorized person
| Name | JOEL K GOLOSKIE |
| Role | COUNSEL |
| Phone | 6177711154 |
Taxonomy
| Taxonomy Code | 101YA0400X - Addiction (Substance Use Disorder) Counselor |
| Is Primary | No |
| Taxonomy Code | 103TA0400X - Addiction (Substance Use Disorder) Psychologist |
| Is Primary | Yes |
| Taxonomy Code | 104100000X - Social Worker |
| Is Primary | No |
| Taxonomy Code | 163WA0400X - Addiction (Substance Use Disorder) Registered Nurse |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| JOEL K. GOLOSKIE | Agent | 1301 ATWOOD AVENUE SUITE 215N, JOHNSTON, RI, 02919, USA |
| Number | Name | File Date |
|---|---|---|
| 202210546330 | Revocation Certificate For Failure to File the Annual Report for the Year | 2022-02-14 |
| 202106444210 | Revocation Notice For Failure to File An Annual Report | 2021-12-03 |
| 202041343580 | Articles of Organization | 2020-06-03 |
Date of last update: 27 Oct 2024
Sources: Rhode Island Department of State
