| 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)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 | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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: 06 Apr 2025
Sources: Rhode Island Department of State
