| 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 Centers |
| 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
