| Name: | Phoenix Rising Centers LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 20 Jun 2022 (3 years ago) |
| Identification Number: | 001742232 |
| ZIP code: | 02879 |
| County: | Washington County |
| Principal Address: | 313 MAIN ST G, WAKEFIELD, RI, 02879, USA |
| Purpose: | PSYCHOTHERAPY PRACTICE IN THE STATE OF RHODE ISLAND. |
| NAICS: | 621330 - Offices of Mental Health Practitioners (except Physicians) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376276832 | 2022-07-02 | 2022-10-13 | PO BOX 5, KINGSTON, RI, 028810005, US | 1 RICHMOND SQ STE 333C, PROVIDENCE, RI, 029065139, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 401-441-5834 |
| Fax | 4012108248 |
| Phone | +1 401-297-0692 |
Authorized person
| Name | MADRONE B. PHOENIX |
| Role | OWNER |
| Phone | 4014415834 |
Taxonomy
| Taxonomy Code | 101Y00000X - Counselor |
| Is Primary | No |
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 101YP2500X - Professional Counselor |
| Is Primary | No |
| Taxonomy Code | 103T00000X - Psychologist |
| Is Primary | No |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | Yes |
| Taxonomy Code | 106H00000X - Marriage & Family Therapist |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| MADRONE PHOENIX | Agent | 1 RICHMOND SQUARE 333W, PROVIDENCE, RI, 02906, USA |
| Number | Name | File Date |
|---|---|---|
| 202453974460 | Annual Report | 2024-05-07 |
| 202327936590 | Annual Report | 2023-02-09 |
| 202218654910 | Articles of Organization | 2022-06-20 |
Date of last update: 28 Oct 2024
Sources: Rhode Island Department of State
