| Name: | The Burrillville Nursing Home, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 29 Oct 1982 (42 years ago) |
| Identification Number: | 000003120 |
| ZIP code: | 02907 |
| County: | Providence County |
| Principal Address: | 359 BROAD STREET, PROVIDENCE, RI, 02907, USA |
| Purpose: | TO CONSTRUCT, REHABILITATE OR ACQUIRE AND OPERATE A NURSING HOME DEVELOPMENT |
| NAICS: | 623110 - Nursing Care Facilities (Skilled Nursing Facilities) |
| Fictitious names: |
Pine Grove Health Center (trading name, 1994-03-09 - ) Lincoln Green (trading name, 1992-01-29 - 2010-06-10) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538158456 | 2005-10-14 | 2020-08-22 | 999 S MAIN ST, PASCOAG, RI, 028593522, US | 999 S MAIN ST, PASCOAG, RI, 028593522, US | |||||||||||||||||||||||||
|
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| Phone | +1 401-568-3091 |
| Fax | 4015688070 |
Authorized person
| Name | MR. THOMAS LLOYD RYAN |
| Role | PRESIDENT OWNER |
| Phone | 4015683091 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 601 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4105099 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| WYATT A BROCHU | Agent | 1130 TEN ROD ROAD SUITE D102, NORTH KINGSTOWN, RI, 02852, USA |
| Name | Role | Address |
|---|---|---|
| CHRISTOPHER RYAN | PRESIDENT | 999 SOUTH MAIN STREET PASCOAG, RI 02859 USA |
| Name | Role | Address |
|---|---|---|
| CHRISTOPHER RYAN | TREASURER | 999 SOUTH MAIN STREET PASCOAG, RI 02859 USA |
| Name | Role | Address |
|---|---|---|
| CHRISTOPHER RYAN | SECRETARY | 999 SOUTH MAIN STREET PASCOAG, RI 02859 USA |
| Number | Name | File Date |
|---|---|---|
| 202454711640 | Annual Report | 2024-05-21 |
| 202336676700 | Annual Report | 2023-06-08 |
| 202216292420 | Annual Report | 2022-04-29 |
| 202105334530 | Statement of Change of Registered/Resident Agent Office | 2021-11-24 |
| 202195169270 | Annual Report | 2021-03-31 |
| 202036817980 | Annual Report | 2020-03-26 |
| 201988619310 | Annual Report | 2019-03-14 |
| 201861247760 | Annual Report | 2018-03-30 |
| 201738293670 | Annual Report | 2017-03-20 |
| 201693230330 | Annual Report | 2016-02-26 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DELIVERY ORDER | AWARD | VA241BO0105FY10 | 2009-10-01 | 2010-09-30 | 2010-09-30 | |||||||||||||||||||||||||
|
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| Obligated Amount | 320000.00 |
| Current Award Amount | 320000.00 |
| Potential Award Amount | 320000.00 |
Description
| Title | NURSING HOME FPDS FOR 1358 PAYMENTS FY10 |
| NAICS Code | 623110: NURSING CARE FACILITIES |
| Product and Service Codes | Q402: NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | BURRILLVILLE NURSING HOME |
| UEI | YUSEWEH6DGN5 |
| Recipient Address | 999 S MAIN ST, PASCOAG, PROVIDENCE, RHODE ISLAND, 028593522, UNITED STATES |
| Unique Award Key | CONT_IDV_VA241BO0105_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Award Amounts
| Obligated Amount | 504049.00 |
| Potential Award Amount | 504049.00 |
Description
| NAICS Code | 623110: NURSING CARE FACILITIES |
| Product and Service Codes | Q402: NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | BURRILLVILLE NURSING HOME |
| UEI | YUSEWEH6DGN5 |
| Recipient Address | 999 S MAIN ST, PASCOAG, PROVIDENCE, RHODE ISLAND, 028593522, UNITED STATES |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 312341647 | 0112300 | 2009-04-23 | 999 SOUTH MAIN STREET, PASCOAG, RI, 02859 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
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| Citation ID | 01001 |
| Citaton Type | Serious |
| Standard Cited | 19100147 C04 II |
| Issuance Date | 2009-05-11 |
| Abatement Due Date | 2009-05-24 |
| Current Penalty | 412.5 |
| Initial Penalty | 825.0 |
| Nr Instances | 1 |
| Nr Exposed | 2 |
| Gravity | 01 |
| Citation ID | 01002 |
| Citaton Type | Serious |
| Standard Cited | 19100151 C |
| Issuance Date | 2009-05-11 |
| Abatement Due Date | 2009-05-19 |
| Current Penalty | 412.5 |
| Initial Penalty | 825.0 |
| Nr Instances | 1 |
| Nr Exposed | 2 |
| Gravity | 01 |
Date of last update: 05 Oct 2024
Sources: Rhode Island Department of State
