| 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 & REHABILITATION FACILITY |
| NAICS: | 623110 - Nursing Care Facilities (Skilled Nursing Facilities) |
| Fictitious names: |
Golden Crest Nursing Centre (trading name, 2019-01-16 - ) |
| 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 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
