| Name: | Providence Wellness, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 06 Aug 2021 (4 years ago) |
| Date of Dissolution: | 11 Sep 2023 (2 years ago) |
| Date of Status Change: | 11 Sep 2023 (2 years ago) |
| Identification Number: | 001727827 |
| ZIP code: | 02907 |
| County: | Providence County |
| Principal Address: | 669 PUBLIC STREET, PROVIDENCE, RI, 02907, USA |
| Purpose: | OUTPATIENT MENTAL HEALTH TREATMENT |
NAICS
621330 Offices of Mental Health Practitioners (except Physicians)This industry comprises establishments of independent mental health practitioners (except physicians) primarily engaged in (1) the diagnosis and treatment of mental, emotional, and behavioral disorders and/or (2) the diagnosis and treatment of individual or group social dysfunction brought about by such causes as mental illness, alcohol and substance abuse, physical and emotional trauma, or stress. 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 | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659046936 | 2021-08-10 | 2021-08-10 | 669 PUBLIC ST, PROVIDENCE, RI, 029071640, US | 669 PUBLIC ST, PROVIDENCE, RI, 029071640, US | |||||||||||||
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| Phone | +1 401-585-3729 |
Authorized person
| Name | ALEXANDER KAROFF HUNGER |
| Role | LEAD CLINICIAN |
| Phone | 4015853729 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ALEXANDER KAROFF-HUNGER | Agent | 669 PUBLIC STREET, PROVIDENCE, RI, 02907, USA |
| Number | Name | File Date |
|---|---|---|
| 202341086970 | Revocation Certificate For Failure to File the Annual Report for the Year | 2023-09-11 |
| 202337375440 | Revocation Notice For Failure to File An Annual Report | 2023-06-16 |
| 202220914190 | Annual Report | 2022-07-11 |
| 202219285230 | Revocation Notice For Failure to File An Annual Report | 2022-06-22 |
| 202100019360 | Articles of Organization | 2021-08-06 |
Date of last update: 28 Oct 2024
Sources: Rhode Island Department of State
