| 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 |
| NAICS: | 623110 - Nursing Care Facilities (Skilled Nursing Facilities) |
| 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 - ) |
| 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 | |||||||||||||||
|
|||||||||||||||||||
| 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
