| 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 (2 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 |
| NAICS: | 621112 - Offices of Physicians, Mental Health Specialists |
| Historical names: |
Emmanuel Medical LLC. |
| 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
