| Name: | Crestwood Nursing & Rehabilitation Center, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 12 Sep 1978 (46 years ago) |
| Identification Number: | 000005231 |
| ZIP code: | 02885 |
| County: | Bristol County |
| Principal Address: | 568 CHILD STREET, WARREN, RI, 02885, USA |
| Purpose: | OPERATION AND CONDUCT OF A GENERAL NURSING CARE AND CONVALESCENT FACILITY |
| NAICS: | 623110 - Nursing Care Facilities (Skilled Nursing Facilities) |
| Historical names: |
CRESTWOOD NURSING AND CONVALESCENT HOME, INC. |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205822517 | 2005-09-22 | 2015-10-19 | 568 CHILD ST, WARREN, RI, 028851734, US | 568 CHILD ST, WARREN, RI, 028851734, US | |||||||||||||||||||||||||
|
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| Phone | +1 401-245-1574 |
| Fax | 4012470211 |
Authorized person
| Name | MR. GARY M MINASSIAN |
| Role | ADMINISTRATOR |
| Phone | 4012451574 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 628 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 628 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| CHACE RUTTENBERG & FREEDMAN, LLP | Agent | ONE PARK ROW SUITE 300, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| GARY M MINASSIAN | PRESIDENT | P. O. BOX 308 WARREN, RI 02885 USA |
| Name | Role | Address |
|---|---|---|
| GAIL V MINASSIAN | TREASURER | P. O. BOX 308 WARREN, RI 02885 USA |
| Name | Role | Address |
|---|---|---|
| GREGORY J MINASSIAN | SECRETARY | P. O. BOX 308 WARREN, RI 02885 USA |
| Name | Role | Address |
|---|---|---|
| GREGORY J MINASSIAN | VICE PRESIDENT | P. O. BOX 308 WARREN, RI 02885 USA |
| Name | Role | Address |
|---|---|---|
| GARY M MINASSIAN | DIRECTOR | P. O. BOX 308 WARREN, RI 02885 USA |
| GREGORY J MINASSIAN | DIRECTOR | P. O. BOX 308 WARREN, RI 02885 USA |
| GAIL V MINASSIAN | DIRECTOR | P. O. BOX 308 WARREN, RI 02885 USA |
| MARK MINASSIAN | DIRECTOR | P. O. BOX 308 WARREN , RI 02885 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2016-01-08 | CRESTWOOD NURSING AND CONVALESCENT HOME, INC. | Crestwood Nursing & Rehabilitation Center, Inc. |
| Number | Name | File Date |
|---|---|---|
| 202452994180 | Annual Report | 2024-04-29 |
| 202328347160 | Annual Report | 2023-02-14 |
| 202209718650 | Annual Report | 2022-02-08 |
| 202191905890 | Annual Report | 2021-02-18 |
| 202038148910 | Statement of Change of Registered/Resident Agent | 2020-04-21 |
| 202033099370 | Annual Report | 2020-01-27 |
| 201985345140 | Annual Report | 2019-01-29 |
| 201857584970 | Annual Report | 2018-02-05 |
| 201734665480 | Annual Report | 2017-02-24 |
| 201691109890 | Annual Report | 2016-01-22 |
Date of last update: 05 Oct 2024
Sources: Rhode Island Department of State
