| Name: | Opal Behavioral Health LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 06 Jan 2023 (2 years ago) |
| Identification Number: | 001750729 |
| ZIP code: | 02903 |
| County: | Providence County |
| Principal Address: | 383 W FOUNTAIN ST SUITE 103, PROVIDENCE, RI, 02903, USA |
| Mailing Address: | 3 RINGGOLD ST, PROVIDENCE, RI, 02903, USA |
| Purpose: | PSYCHIATRIC AND THERAPEUTIC TREATMENT FOR BEHAVIORAL HEALTH CONDITIONS OF ADULTS IN AN OFFICE SETTING. |
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 | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851098479 | 2023-02-14 | 2023-04-05 | 3 RINGGOLD ST, PROVIDENCE, RI, 029031432, US | 383 W FOUNTAIN ST STE 103, PROVIDENCE, RI, 029033515, US | |||||||||||||||||||||||||||
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| Phone | +1 401-217-9377 |
| Fax | 4012003166 |
Authorized person
| Name | SUSANNA DRAIGHAN |
| Role | OWNER |
| Phone | 4012179377 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BOARD OF NURSING |
| Number | RN2327944 |
| State | MA |
| Issuer | BOARD OF NURSING |
| Number | APRN01685 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| SUSANNA DRAINE | Agent | 3 RINGGOLD STREET, PROVIDENCE, RI, 02903, USA |
| Number | Name | File Date |
|---|---|---|
| 202453435240 | Annual Report | 2024-04-30 |
| 202325812030 | Articles of Organization | 2023-01-06 |
Date of last update: 29 Oct 2024
Sources: Rhode Island Department of State
