| Name: | MediTelecare of Rhode Island, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 13 Apr 2021 (4 years ago) |
| Identification Number: | 001722213 |
| Principal Address: | 213 COURT STREET 6TH FLOOR, MIDDLETOWN, CT, 06457, USA |
| Purpose: | TELEHEALTH PROVIDER IN SKILLED NURSING FACILITIES |
NAICS
621112 Offices of Physicians, Mental Health SpecialistsThis U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of psychiatry or psychoanalysis. 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 | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801477963 | 2021-04-19 | 2024-09-04 | PO BOX 1595, MIDDLETOWN, CT, 064578095, US | 222 JEFFERSON BLVD STE 200, WARWICK, RI, 028883855, US | |||||||||||||||||||||||||||||||
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| Phone | +1 860-788-6404 |
| Fax | 8608290495 |
Authorized person
| Name | ANDREA GODFREY |
| Role | CREDENTIALING & ENROLLMENT MANAGER |
| Phone | 8607886404 |
Taxonomy
| Taxonomy Code | 103T00000X - Psychologist |
| Is Primary | No |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY | Agent | 222 JEFFERSON BOULEVARD SUITE 200, WARWICK, RI, 02888, USA |
| Name | Role | Address |
|---|---|---|
| STEVEN W. POWELL, M.D. | Manager | 213 COURT STREET, 6TH FLOOR MIDDLETOWN, CT 06457 USA |
| Number | Name | File Date |
|---|---|---|
| 202342858170 | Annual Report | 2023-11-21 |
| 202342858350 | Annual Report | 2023-11-21 |
| 202342858530 | Annual Report | 2023-11-21 |
| 202342857920 | Reinstatement | 2023-11-21 |
| 202223663220 | Revocation Certificate For Failure to File the Annual Report for the Year | 2022-10-11 |
| 202219360810 | Revocation Notice For Failure to File An Annual Report | 2022-06-22 |
| 202195705720 | Articles of Organization | 2021-04-13 |
Date of last update: 28 Oct 2024
Sources: Rhode Island Department of State
