| 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) |
| 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
