| Name: | Ocean State Behavioral Health LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 08 Jun 2020 (5 years ago) |
| Identification Number: | 001708532 |
| ZIP code: | 02919 |
| County: | Providence County |
| Principal Address: | 1524 ATWOOD AVE SUITE 244, JOHNSTON, RI, 02919, USA |
| Purpose: | PROVIDER OF BEHAVIORAL HEALTH SERVICES |
| NAICS: | 621420 - Outpatient Mental Health and Substance Abuse Centers |
| Fictitious names: |
Ocean State Recovery Center (trading name, 2020-12-16 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508462128 | 2020-12-09 | 2020-12-09 | 1524 ATWOOD AVE STE 244, JOHNSTON, RI, 029193228, US | 1524 ATWOOD AVE STE 244, JOHNSTON, RI, 029193228, US | |||||||||||||
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| Phone | +1 401-626-0169 |
Authorized person
| Name | CHRISTOPHER DORVAL |
| Role | PROVIDER |
| Phone | 4016260169 |
Taxonomy
| Taxonomy Code | 261QR0405X - Substance Use Disorder Rehabilitation Clinic/Center |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OCEAN STATE RECOVERY CENTER 401(K) PLAN | 2023 | 851328170 | 2024-05-24 | OCEAN STATE BEHAVIORAL HEALTH LLC. | 13 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-24 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 812990 |
| Sponsor’s telephone number | 4016260169 |
| Plan sponsor’s address | 1524 ATWOOD AVENUE, SUITE 244, JOHNSTON, RI, 02919 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-12 |
| Name of individual signing | CHRIS DORVAL |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 812990 |
| Sponsor’s telephone number | 4016260169 |
| Plan sponsor’s address | 1524 ATWOOD AVENUE SUITE 244, JOHNSTON, RI, 02919 |
Signature of
| Role | Plan administrator |
| Date | 2022-04-04 |
| Name of individual signing | EDWARD ROJAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| CHRIS DORVAL | Agent | 1524 ATWOOD AVE SUITE 244, JOHNSTON, RI, 02919, USA |
| Number | Name | File Date |
|---|---|---|
| 202444044840 | Annual Report | 2024-01-16 |
| 202326204690 | Annual Report | 2023-01-19 |
| 202208285450 | Annual Report | 2022-01-20 |
| 202198667430 | Annual Report | 2021-06-25 |
| 202198666370 | Statement of Change of Registered/Resident Agent Office | 2021-06-25 |
| 202080274360 | Fictitious Business Name Statement | 2020-12-16 |
| 202041639160 | Articles of Organization | 2020-06-08 |
Date of last update: 27 Oct 2024
Sources: Rhode Island Department of State
