| Name: | Emmanuel Medical Services LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 21 Sep 2022 (3 years ago) |
| Identification Number: | 001746368 |
| ZIP code: | 02903 |
| County: | Providence County |
| Principal Address: | 10 DORRANCE STREET SUITE 700, PROVIDENCE, RI, 02903, USA |
| Mailing Address: | 1417 DOUGLAS AVE, NORTH PROVIDENCE, RI, 02904, USA |
| Purpose: | MEDICAL PRACTIONER, PATIENT'S HOME VISITS, MENTAL HEALTH SERVICES |
| Historical names: |
Emmanuel Medical LLC. |
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 | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861274813 | 2023-10-16 | 2023-10-16 | 10 DORRANCE ST STE 700, PROVIDENCE, RI, 029032014, US | 1417 DOUGLAS AVE STE 2, NORTH PROVIDENCE, RI, 029044057, US | |||||||||||||||||||||
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| Phone | +1 401-200-8242 |
| Fax | 4014150418 |
Authorized person
| Name | AMOS ADELAIYE |
| Role | OFFICE MANAGER |
| Phone | 4012008242 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | EM17385 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| DR. ADEBOLA ADELAIYE | Agent | 10 DORRANCE STREET SUITE 700, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| AMOS ADELAIYE | MANAGER | 20 SYLVIA LN LINCOLN, RI 02865 USA |
| ADEBOLA ADELAIYE | MANAGER | 20 SYLVIA LN LINCOLN, RI 02865 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2022-12-13 | Emmanuel Medical LLC. | Emmanuel Medical Services LLC |
| Number | Name | File Date |
|---|---|---|
| 202453451330 | Annual Report | 2024-04-30 |
| 202339347300 | Annual Report | 2023-07-11 |
| 202337593240 | Revocation Notice For Failure to File An Annual Report | 2023-06-16 |
| 202225168930 | Articles of Amendment | 2022-12-13 |
| 202222924250 | Articles of Organization | 2022-09-21 |
Date of last update: 28 Oct 2024
Sources: Rhode Island Department of State
