| Name: | Optum Behavioral Care of Connecticut, P.C. |
| Jurisdiction: | Rhode Island |
| Entity type: | Foreign Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 21 Jul 2023 (2 years ago) |
| Branch of: | Optum Behavioral Care of Connecticut, P.C., CONNECTICUT (Company Number 2813207) |
| Identification Number: | 001760631 |
| Place of Formation: | CONNECTICUT |
| Principal Address: | 11000 OPTUM CIRCLE, EDEN PRAIRIE, MN, 55344, US |
| Purpose: | MEDICINE, NURSING, PSYCHOLOGY, PROFESSIONAL COUNSELING, SOCIAL WORK AND MARRIAGE AND FAMILY THERAPY |
| Fictitious names: |
Tides of Mind Counseling of Rhode Island (trading name, 2023-10-11 - ) RICBT Rhode Island (trading name, 2023-10-11 - ) Optum Behavioral Care of Rhode Island (trading name, 2023-07-21 - ) |
NAICS
623110 Nursing Care Facilities (Skilled Nursing Facilities)This industry comprises establishments primarily engaged in providing inpatient nursing and rehabilitative services. The care is generally provided for an extended period of time to individuals requiring nursing care. These establishments have a permanent core staff of registered or licensed practical nurses who, along with other staff, provide nursing and continuous personal care services. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003688037 | 2023-10-24 | 2023-12-07 | 67 BURNSIDE AVE, EAST HARTFORD, CT, 061083408, US | 245 WATERMAN ST STE 200, PROVIDENCE, RI, 029065215, US | |||||||||||||||
|
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| Phone | +1 952-246-4564 |
| Phone | +1 401-369-8192 |
Authorized person
| Name | AMANDA BRONSON |
| Role | CEO |
| Phone | 7045066267 |
Taxonomy
| Taxonomy Code | 103TC1900X - Counseling Psychologist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 450 VETERANS MEMORIAL PARKWAY SUITE 7A, EAST PROVIDENCE, RI, 02914, USA |
| Name | Role | Address |
|---|---|---|
| JAMIE M. DUPUY M.D. | PRESIDENT | 11000 OPTUM CIRCLE EDEN PRAIRIE, MN 55344 USA |
| Name | Role | Address |
|---|---|---|
| JAMIE M. DUPUY M.D. | TREASURER | 11000 OPTUM CIRCLE EDEN PRAIRIE, MN 55344 USA |
| Name | Role | Address |
|---|---|---|
| JAMIE M. DUPUY M.D. | SECRETARY | 11000 OPTUM CIRCLE EDEN PRAIRIE, MN 55344 USA |
| Name | Role | Address |
|---|---|---|
| ELIZABETH ANN SODERBERG | OTHER OFFICER | 120 SOUTH CENTRAL AVENUE CLAYTON, MO 63105 IND |
| Name | Role | Address |
|---|---|---|
| JAMIE M. DUPUY M.D. | DIRECTOR | 11000 OPTUM CIRCLE EDEN PRAIRIE, MN 55344 USA |
| Number | Name | File Date |
|---|---|---|
| 202453249180 | Annual Report | 2024-04-30 |
| 202342153950 | Fictitious Business Name Statement | 2023-10-11 |
| 202342153590 | Fictitious Business Name Statement | 2023-10-11 |
| 202339674460 | Fictitious Business Name Statement | 2023-07-21 |
| 202339672600 | Application for Certificate of Authority | 2023-07-21 |
Date of last update: 29 Oct 2024
Sources: Rhode Island Department of State
