| Name: | PEZZELLI NURSING HOME, INC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 15 May 1968 (57 years ago) |
| Identification Number: | 000017894 |
| ZIP code: | 02904 |
| County: | Providence County |
| Principal Address: | 100 SMITHFIELD ROAD, NORTH PROVIDENCE, RI, 02904, USA |
| Purpose: | SKILLED NURSING FACILITY |
| Fictitious names: |
Golden Crest Nursing Centre (trading name, 2019-01-16 - ) |
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 | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831185198 | 2005-09-22 | 2020-08-22 | 100 SMITHFIELD RD, NORTH PROVIDENCE, RI, 029045311, US | 100 SMITHFIELD RD, NORTH PROVIDENCE, RI, 029045311, US | |||||||||||||||||||||||||
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| Phone | +1 401-353-1710 |
| Fax | 4013531618 |
Authorized person
| Name | MR. PAUL M PEZZELLI |
| Role | ADMINISTRATOR |
| Phone | 4013531710 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 543 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 543 |
| State | ID |
| LEI number | Registered As | Jurisdiction Of Formation | General Category | Entity Status | Entity created at | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 549300UFPW775OBCP504 | 000017894 | US-RI | GENERAL | ACTIVE | No data | |||||||||||||||||||
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| Legal | C/O Norma M. Pezzelli, 262 Poplar Street, Woonsocket, US-RI, US, 02895 |
| Headquarters | 100 Smithfield Road, North Providence, US-RI, US, 02904 |
Registration details
| Registration Date | 2016-05-17 |
| Last Update | 2023-08-04 |
| Status | LAPSED |
| Next Renewal | 2017-05-13 |
| LEI Issuer | 5493001KJTIIGC8Y1R12 |
| Corroboration Level | FULLY_CORROBORATED |
| Data Validated As | 000017894 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PEZZELLI NURSING HOME, INC. 401(K) PROFIT SHARING PLAN | 2023 | 105034001 | 2024-09-25 | PEZZELLI NURSING HOME, INC. | 127 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-09-25 |
| Name of individual signing | SUSAN MARANDOLA |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| NORMA M. PEZZELLI | Agent | 262 POPLAR STREET, WOONSOCKET, RI, 02895, USA |
| Name | Role | Address |
|---|---|---|
| PAUL PEZZELLI | PRESIDENT | 100 SMITHFIELD ROAD NORTH PROVIDENCE, RI 02904 USA |
| Name | Role | Address |
|---|---|---|
| PAUL PEZZELLI | TREASURER | 100 SMITHFIELD ROAD NORTH PROVIDENCE, RI 02904 USA |
| Name | Role | Address |
|---|---|---|
| PAUL PEZZELLI | SECRETARY | 100 SMITHFIELD ROAD NORTH PROVIDENCE, RI 02904 USA |
| Number | Name | File Date |
|---|---|---|
| 202447139110 | Annual Report | 2024-02-23 |
| 202336530390 | Annual Report - Amended | 2023-06-02 |
| 202326280360 | Annual Report | 2023-01-20 |
| 202208201180 | Annual Report | 2022-01-19 |
| 202184236660 | Annual Report | 2021-01-05 |
| 202032027310 | Annual Report | 2020-01-13 |
| 201984511870 | Fictitious Business Name Statement | 2019-01-16 |
| 201984509480 | Annual Report - Amended | 2019-01-16 |
| 201983667000 | Annual Report | 2019-01-03 |
| 201855768750 | Annual Report | 2018-01-08 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 8464917110 | 2020-04-15 | 0165 | PPP | 100 SMITHFIELD RD, NORTH PROVIDENCE, RI, 02904-5382 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 06 Apr 2025
Sources: Rhode Island Department of State
