| Name: | Bannister House, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Non-Profit Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 02 Jan 1890 (135 years ago) |
| Date of Dissolution: | 22 Sep 2017 (7 years ago) |
| Date of Status Change: | 22 Sep 2017 (7 years ago) |
| Identification Number: | 000026992 |
| ZIP code: | 02907 |
| County: | Providence County |
| Principal Address: | 135 DODGE STREET, PROVIDENCE, RI, 02907, USA |
| Purpose: | NURSING FACILITY JANUARY SESSION 1890 |
| Historical names: |
BANNISTER NURSING CARE CENTER Bannister Health & Rehabilitation Center, Inc. |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427177005 | 2007-03-28 | 2020-08-22 | 135 DODGE ST, PROVIDENCE, RI, 029072210, US | 135 DODGE ST, PROVIDENCE, RI, 029072210, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 401-521-9600 |
| Fax | 4012743233 |
Authorized person
| Name | MS. CAROL A. MANCINI |
| Role | ADMINISTRATOR |
| Phone | 4015219600 |
Taxonomy
| Taxonomy Code | 3140N1450X - Pediatric Skilled Nursing Facility |
| License Number | LTC00600 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4105038 |
| State | RI |
| Issuer | BLUE CROSS |
| Number | 5005-0 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| CASBY HARRISON | Agent | 807 BROAD STREET, PROVIDENCE, RI, 02907, USA |
| Name | Role | Address |
|---|---|---|
| CASBY HARRISON III | SECRETARY | 807 BROAD STREET PROVIDENCE, RI 02907 USA |
| Name | Role | Address |
|---|---|---|
| SUSAN JOHNSON | DIRECTOR | 10 WEYBOSSET STREET, STE 700 PROVIDENCE, RI 02903 USA |
| JANE HAYWARD | DIRECTOR | 235 PROMENADE STREET PROVIDENCE, RI 02908 USA |
| DENISE BARGE | DIRECTOR | 315 IRON HORSE WAY PROVIDENCE, RI 02907 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2001-06-04 | Bannister Health & Rehabilitation Center, Inc. | Bannister House, Inc. |
| Name Change | 1999-04-21 | BANNISTER NURSING CARE CENTER | Bannister Health & Rehabilitation Center, Inc. |
| Number | Name | File Date |
|---|---|---|
| 201750597220 | Articles of Dissolution | 2017-09-22 |
| 201561829590 | Order Appointing Permanent Receiver | 2015-05-04 |
| 201561162390 | Order Appointing Temporary Receiver | 2015-04-07 |
| 201445754110 | Annual Report | 2014-09-10 |
| 201330832600 | Annual Report | 2013-11-21 |
| 201330596700 | Revocation Notice For Failure to File An Annual Report | 2013-11-14 |
| 201204463170 | Annual Report | 2012-12-04 |
| 201204463080 | Annual Report | 2012-12-04 |
| 201204462920 | Annual Report | 2012-12-04 |
| 201204463260 | Annual Report | 2012-12-04 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
