| Name: | Liberty Advanced Integrative Care LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 12 Oct 2023 (a year ago) |
| Date of Dissolution: | 17 Sep 2024 (4 months ago) |
| Date of Status Change: | 17 Sep 2024 (4 months ago) |
| Identification Number: | 001764256 |
| ZIP code: | 02813 |
| County: | Washington County |
| Principal Address: | 3769 OLD POST ROAD, CHARLESTOWN, RI, 02813, USA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417723933 | 2023-11-27 | 2024-08-22 | 3769 OLD POST RD STE C, CHARLESTOWN, RI, 028132571, US | 3769 OLD POST RD STE C, CHARLESTOWN, RI, 028132571, US | |||||||||||||||
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| Phone | +1 401-854-7955 |
| Fax | 8775012230 |
Authorized person
| Name | DR. WENDY HOLLAND |
| Role | CLINICAL DIRECTOR/CEO |
| Phone | 4018547955 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WENDY HOLLAND | Agent | 126 MAIL ROAD, EXETER, RI, 02822, USA |
| Number | Name | File Date |
|---|---|---|
| 202460137630 | Revocation Certificate For Failure to File the Annual Report for the Year | 2024-09-17 |
| 202456439010 | Revocation Notice For Failure to File An Annual Report | 2024-06-18 |
| 202342223400 | Articles of Organization | 2023-10-12 |
Date of last update: 29 Oct 2024
Sources: Rhode Island Department of State
