| Name: | Scandinavian Home, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Non-Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 12 May 1930 (95 years ago) |
| Identification Number: | 000030972 |
| ZIP code: | 02905 |
| County: | Providence County |
| Principal Address: | 1811 BROAD STREET, CRANSTON, RI, 02905, USA |
| Purpose: | SKILLED NURSING FACILITY AND ASSISTED LIVING FACILITY |
| NAICS: | 624120 - Services for the Elderly and Persons with Disabilities |
| Fictitious names: |
Scandinavian Communities (trading name, 2017-11-20 - ) |
| Historical names: |
The Scandinavian Old Peoples Home Association of Rhode Island, Incorporated Scandinavian Home Inc. SCANDINAVIAN HOME FOR THE AGED |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922031665 | 2006-07-08 | 2008-01-23 | 1811 BROAD STREET, CRANSTON, RI, 02905, US | 1811 BROAD ST, CRANSTON, RI, 029053533, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 401-461-1433 |
| Fax | 4014614005 |
Authorized person
| Name | MRS. LINDA TUCKER |
| Role | ADMINISTRATOR |
| Phone | 4014611433 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 00390 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UNITED HEALTH PROVIDER NU |
| Number | 740800 |
| State | RI |
| Issuer | BLUE CHIP PROVIDER NUMBER |
| Number | 405363 |
| State | RI |
| Issuer | BLUE CROSS PROVIDER NUMBE |
| Number | 54375 |
| State | RI |
| Issuer | MEDICAID |
| Number | 4105051 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| SUZANNE M. CESANA | Agent | 1811 BROAD STREET, CRANSTON, RI, 02905, USA |
| Name | Role | Address |
|---|---|---|
| PAUL SWANSON | PRESIDENT | 1811 BROAD STREET CRANSTON, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| WAYNE KEZIRIAN | TREASURER | 1811 BROAD STREET CRANSTON, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| RONALD S. OSHBERG | SECRETARY | 1811 BROAD STREET CRANSTON, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| JOEL JOHNSON | VICE PRESIDENT | 1811 BROAD STREET CRANSTON, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| PAUL CALITRI | DIRECTOR | 1811 BROAD STREET CRANSTON, RI 02905 USA |
| KATHERINE DESIMONE | DIRECTOR | 1811 BROAD STREET CRANSTON, RI 02905 USA |
| JEAN LARKIN | DIRECTOR | 1811 BROAD STREET CRANSTON, RI 02905 USA |
| SAMANTHA MCCARTHY | DIRECTOR | 1811 BROAD STREET CRANSTON, RI 02905 USA |
| LEIF RESLOW | DIRECTOR | 1811 BROAD STREET CRANSTON, RI 02905 USA |
| PATRICIA THOMAS | DIRECTOR | 1811 BROAD STREET CRANSTON, RI 02905 USA |
| ALLEN R. WATERS | DIRECTOR | 1811 BROAD STREET CRANSTON, RI 02905 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 1992-07-14 | SCANDINAVIAN HOME FOR THE AGED | Scandinavian Home, Inc. |
| Name Change | 1962-12-07 | Scandinavian Home Inc. | SCANDINAVIAN HOME FOR THE AGED |
| Name Change | 1955-05-27 | The Scandinavian Old Peoples Home Association of Rhode Island, Incorporated | Scandinavian Home Inc. |
| Number | Name | File Date |
|---|---|---|
| 202446517720 | Annual Report | 2024-02-15 |
| 202341757050 | Annual Report - Amended | 2023-09-18 |
| 202339071980 | Annual Report | 2023-07-05 |
| 202338411020 | Revocation Notice For Failure to File An Annual Report | 2023-06-20 |
| 202210122930 | Annual Report | 2022-02-11 |
| 202101954930 | Statement of Change of Registered/Resident Agent | 2021-09-22 |
| 202198650900 | Annual Report | 2021-06-25 |
| 202043740990 | Annual Report | 2020-06-29 |
| 201906912570 | Annual Report | 2019-07-23 |
| 201878117720 | Statement of Change of Registered/Resident Agent | 2018-09-24 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
