| Entity Name: | PROSPECT WATERBURY, INC. |
| Jurisdiction: | Connecticut |
| Legal type: | Stock |
| Citizenship: | Domestic |
| Status: | Active |
| Sub status: | Annual report due |
| Date Formed: | 08 Apr 2016 |
| Business ALEI: | 1202801 |
| Annual report due: | 08 Apr 2025 |
| NAICS code: | 622110 - General Medical and Surgical Hospitals |
| Business address: | 3824 Hughes Ave, Culver City, CA, 90232, United States |
| Mailing address: | 3824 Hughes Ave, Culver City, CA, United States, 90232 |
| Place of Formation: | CONNECTICUT |
| Total authorized shares: | 1000 |
| E-Mail: | cls-ctarmsevidence@wolterskluwer.com |
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LCRYXFSAJ9X7 | 2025-01-30 | 64 ROBBINS ST, WATERBURY, CT, 06708, 2613, USA | 64 ROBBINS STREET, WATERBURY, CT, 06708, 2613, USA | |||||||||||||||||||||||||||||||||||||||||||||||||||||
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| URL | http://www.waterburyhospital.com/ |
| Congressional District | 05 |
| State/Country of Incorporation | CT, USA |
| Activation Date | 2024-02-02 |
| Initial Registration Date | 2006-03-16 |
| Entity Start Date | 2016-10-01 |
| Fiscal Year End Close Date | Sep 30 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | JAMES PHILLIPS |
| Address | 64 ROBBINS STREET, WATERBURY, CT, 06708, 2613, USA |
| Title | ALTERNATE POC |
| Name | CAMILLA LABRIOLA |
| Address | 64 ROBBINS STREET, WATERBURY, CT, 06708, 2613, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | JAMES PHILLIPS |
| Address | 64 ROBBINS STREET, WATERBURY, CT, 06708, 2613, USA |
| Past Performance | |
|---|---|
| Title | PRIMARY POC |
| Name | JOCELYN TORRES |
| Address | 64 ROBBINS STREET, WATERBURY, CT, 06708, 2613, USA |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 4C8F7 | Obsolete | Non-Manufacturer | 2006-03-17 | 2024-03-08 | No data | 2025-01-30 | |||||||||||||
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| POC | JAMES PHILLIPS |
| Phone | +1 203-573-6000 |
| Address | 64 ROBBINS ST, WATERBURY, CT, 06708 2613, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | Information not Available |
|---|
| List of Offerors (0) | Information not Available |
|---|
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| David Hill MD | Director | 3824 Hughes Ave, Culver City, CA, 90232, United States | 3824 Hughes Ave, Culver City, CA, 90232, United States |
| Kimberly Lumia | Director | 3824 Hughes Ave, Culver City, CA, 90232, United States | 3824 Hughes Ave, Culver City, CA, 90232-2716, United States |
| Justin Lundbye MD | Director | 3824 Hughes Ave, Culver City, CA, 90232, United States | 3824 Hughes Ave, Culver City, CA, 90232, United States |
| Von Crockett | Director | 3824 Hughes Ave, Culver City, CA, 90232, United States | 71 Haynes St, Manchester, CT, 06040, United States |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| Frank Saidara | Officer | 3824 Hughes Ave, Culver City, CA, 90232, United States | 71 Haynes St, Manchester, CT, 06040, United States |
| Eric Samuels | Officer | 3824 Hughes Ave, Culver City, CA, 90232, United States | 3824 Hughes Ave, Culver City, CA, 90232-2716, United States |
| Justin Lundbye MD | Officer | 3824 Hughes Ave, Culver City, CA, 90232, United States | 3824 Hughes Ave, Culver City, CA, 90232, United States |
| Credential | Credential type | Status | Status reason | Issue date | Effective date | Expiration date |
|---|---|---|---|---|---|---|
| CSP.0078009-HOSP | CONTROLLED SUBSTANCE REGISTRATION FOR HOSPITALS | INACTIVE | No data | No data | No data | No data |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| BF-0013279602 | 2024-12-02 | No data | Mass Agent Change � Address | Agent Address Change | No data |
| BF-0012408047 | 2024-04-04 | No data | Annual Report | Annual Report | No data |
| BF-0011449122 | 2023-04-08 | No data | Annual Report | Annual Report | No data |
| BF-0010402119 | 2022-03-25 | No data | Annual Report | Annual Report | 2022 |
| 0007302878 | 2021-04-20 | No data | Annual Report | Annual Report | 2021 |
| 0006894916 | 2020-04-29 | No data | Annual Report | Annual Report | 2020 |
| 0006541148 | 2019-04-23 | No data | Annual Report | Annual Report | 2019 |
| 0006145797 | 2018-03-29 | No data | Annual Report | Annual Report | 2018 |
| 0005842639 | 2017-05-12 | No data | Annual Report | Annual Report | 2017 |
| 0005841557 | 2017-05-10 | 2017-05-10 | First Report | Organization and First Report | No data |
Date of last update: 06 Jan 2025
Sources: Connecticut's Official State Website
