| Name: | RI WELLNESS MEDICAL CENTER LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 30 Jun 2021 (4 years ago) |
| Identification Number: | 001726282 |
| ZIP code: | 02904 |
| County: | Providence County |
| Principal Address: | 468 SMITHFIELD ROAD, NORTH PROVIDENCE, RI, 02904, USA |
| Purpose: | PROVIDING CARE TO PATIENTS IN AN OUTPATIENT SETTING |
NAICS
621498 All Other Outpatient Care CentersThis U.S. industry comprises establishments with medical staff primarily engaged in providing general or specialized outpatient care (except family planning centers, outpatient mental health and substance abuse centers, HMO medical centers, kidney dialysis centers, and freestanding ambulatory surgical and emergency centers). Centers or clinics of health practitioners with different degrees from more than one industry practicing within the same establishment (i.e., Doctor of Medicine and Doctor of Dental Medicine) are included in this industry. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659025831 | 2022-02-07 | 2024-10-07 | 468 SMITHFIELD RD, NORTH PROVIDENCE, RI, 029044266, US | 468 SMITHFIELD RD, NORTH PROVIDENCE, RI, 029044266, US | |||||||||||||||||||||||||||||
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| Phone | +1 401-525-8202 |
| Fax | 3088886638 |
| Fax | 3088886636 |
Authorized person
| Name | EUCHARIA U IBEH |
| Role | FAMILY NURSE PRACTITIONER |
| Phone | 4015258202 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1194326991 |
| State | RI |
| Issuer | MEDICAID |
| Number | 1659025831 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| EUCHARIA IBEH | Agent | 4 FINNE ROAD, JOHNSTON, RI, 02919, USA |
| Number | Name | File Date |
|---|---|---|
| 202445618220 | Annual Report | 2024-02-05 |
| 202327460770 | Annual Report | 2023-02-02 |
| 202221302130 | Annual Report | 2022-07-14 |
| 202219783060 | Revocation Notice For Failure to File An Annual Report | 2022-06-22 |
| 202198865430 | Articles of Organization | 2021-06-30 |
Date of last update: 28 Oct 2024
Sources: Rhode Island Department of State
