| Name: | The Burrillville Nursing Home, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 29 Oct 1982 (42 years ago) |
| Date of Dissolution: | 25 Feb 2025 (2 months ago) |
| Date of Status Change: | 25 Feb 2025 (2 months 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 |
| Fictitious names: |
Pine Grove Health Center (trading name, 1994-03-09 - ) Lincoln Green (trading name, 1992-01-29 - 2010-06-10) |
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 | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 Apr 2025
Sources: Rhode Island Department of State
