| Name: | Shady Acres Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 03 Dec 1979 (45 years ago) |
| Date of Dissolution: | 27 Dec 2022 (2 years ago) |
| Date of Status Change: | 27 Dec 2022 (2 years ago) |
| Identification Number: | 000010437 |
| ZIP code: | 02886 |
| County: | Kent County |
| Principal Address: | 57 FREY AVENUE, WARWICK, RI, 02886, USA |
| Purpose: | NURSING HOME |
| NAICS: | 623110 - Nursing Care Facilities (Skilled Nursing Facilities) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346234135 | 2005-09-07 | 2014-09-10 | 415 GARDNER RD, WEST KINGSTON, RI, 028921047, US | 415 GARDNER RD, WEST KINGSTON, RI, 028921047, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 401-295-8520 |
| Fax | 4012941050 |
Authorized person
| Name | MR. CHARLES WILLIAM MIGA |
| Role | PRESIDENT/ADMINISTRATOR |
| Phone | 4012958540 |
Taxonomy
| Taxonomy Code | 313M00000X - Nursing Facility/Intermediate Care Facility |
| License Number | 608 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 608 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CHIP |
| Number | 402416 |
| State | RI |
| Issuer | MEDICAID |
| Number | 4105107 |
| State | RI |
| Issuer | UNITED HEALTHCARE |
| Number | 71-0005 |
| State | RI |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SHADY ACRES, INC. 401(K) PLAN | 2017 | 050384697 | 2018-10-15 | SHADY ACRES, INC. | 0 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2018-10-15 |
| Name of individual signing | IZZY WOLFF |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2016-01-01 |
| Business code | 623000 |
| Sponsor’s telephone number | 4012958520 |
| Plan sponsor’s address | 415 GARDINER ROAD, WEST KINGSTON, RI, 02892 |
Signature of
| Role | Plan administrator |
| Date | 2017-07-28 |
| Name of individual signing | NICHOLAS LUTZEL |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| G. JOHN GAZERRO, JR. ESQ. | Agent | 1551 CENTREVILLE ROAD, WARWICK, RI, 02886, USA |
| Name | Role | Address |
|---|---|---|
| CHARLES MIGA | PRESIDENT | 57 FREY AVENUE WARWICK, RI 02886 USA |
| Number | Name | File Date |
|---|---|---|
| 202225490860 | Articles of Dissolution | 2022-12-27 |
| 202214239030 | Annual Report | 2022-04-01 |
| 202191326190 | Annual Report | 2021-02-12 |
| 202036490660 | Annual Report | 2020-03-16 |
| 201987054950 | Annual Report | 2019-02-19 |
| 201859217920 | Annual Report | 2018-02-26 |
| 201733710190 | Annual Report | 2017-02-06 |
| 201692905310 | Annual Report | 2016-02-22 |
| 201556755220 | Annual Report | 2015-03-09 |
| 201435561540 | Annual Report | 2014-02-13 |
Date of last update: 05 Oct 2024
Sources: Rhode Island Department of State
