| Name: | LIFE CARE CENTERS OF AMERICA, INC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Foreign Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 23 Apr 1986 (39 years ago) |
| Identification Number: | 000038368 |
| Place of Formation: | TENNESSEE |
| Principal Address: | 3570 KEITH STREET NW, CLEVELAND, TN, 37312, USA |
| Purpose: | SKILLED NURSING FACILITY OWNER / MANAGER / OPERATOR |
| NAICS: | 623110 - Nursing Care Facilities (Skilled Nursing Facilities) |
| Fictitious names: |
Evergreen House Health Center (trading name, 2012-11-13 - ) Cherry Hill Manor (trading name, 2012-10-24 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275596108 | 2006-04-11 | 2021-09-15 | 3001 KEITH ST NW, CLEVELAND, TN, 373123713, US | 2 CHERRY HILL RD, JOHNSTON, RI, 029192687, US | |||||||||||||||||||||||||||||
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| Phone | +1 423-473-5751 |
| Fax | 4233398342 |
| Phone | +1 401-231-3102 |
| Fax | 4012325520 |
Authorized person
| Name | CINDY CROSS |
| Role | ASSISTANT SECRETARY |
| Phone | 4234735867 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | LTC00699 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 699 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY | Agent | 222 JEFFERSON BOULEVARD SUITE 200, WARWICK, RI, 02888, USA |
| Name | Role | Address |
|---|---|---|
| STEPHEN ZIEGLER | TREASURER | 3570 KEITH STREET, NW CLEVELAND, TN 37312 USA |
| Name | Role | Address |
|---|---|---|
| LISA M. LAY | SECRETARY | 3570 KEITH STREET, NW CLEVELAND, TN 37312 USA |
| Name | Role | Address |
|---|---|---|
| FORREST L. PRESTON | CEO | 3570 KEITH STREET, NW CLEVELAND, TN 37312 USA |
| Name | Role | Address |
|---|---|---|
| JOAN E. THURMOND | ASSISTANT SECRETARY | 3570 KEITH STREET, NW CLEVELAND, TN 37312 USA |
| CINDY S CROSS | ASSISTANT SECRETARY | 3570 KEITH STREET NW CLEVELAND, TN 37312 USA |
| Name | Role | Address |
|---|---|---|
| TERRY HENRY | ASSISTANT TREASURER | 3570 KEITH STREET, NW CLEVELAND, TN 37312 USA |
| Name | Role | Address |
|---|---|---|
| RICHARD SWANKER | CHIEF TAX OFFICER | 3570 KEITH STREET, NW CLEVELAND, TN 37312 USA |
| Name | Role | Address |
|---|---|---|
| TODD FLETCHER | PRESIDENT | 3570 KEITH STREET, NW CLEVELAND, TN 37312 USA |
| Number | Name | File Date |
|---|---|---|
| 202445181850 | Annual Report | 2024-02-01 |
| 202329739180 | Annual Report | 2023-03-01 |
| 202209689310 | Annual Report | 2022-02-08 |
| 202193615490 | Annual Report | 2021-03-05 |
| 202033996020 | Annual Report | 2020-02-10 |
| 201915755300 | Annual Report | 2019-08-27 |
| 201906968810 | Revocation Notice For Failure to File An Annual Report | 2019-07-24 |
| 201859106260 | Annual Report | 2018-02-26 |
| 201737856920 | Annual Report | 2017-03-10 |
| 201694678690 | Annual Report | 2016-03-14 |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 341644987 | 0112300 | 2015-04-10 | 1 EVERGREEN HOUSE HEALTH CENTER, EAST PROVIDENCE, RI, 02914 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 312338445 | 0112300 | 2008-09-11 | 1 EVERGREEN DRIVE, EAST PROVIDENCE, RI, 02914 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Citation ID | 01001 |
| Citaton Type | Serious |
| Standard Cited | 19100212 A01 |
| Issuance Date | 2008-12-17 |
| Abatement Due Date | 2008-12-26 |
| Current Penalty | 637.5 |
| Initial Penalty | 1275.0 |
| Nr Instances | 1 |
| Nr Exposed | 5 |
| Gravity | 01 |
| Citation ID | 01002 |
| Citaton Type | Serious |
| Standard Cited | 19100303 G01 IA |
| Issuance Date | 2008-12-17 |
| Abatement Due Date | 2008-12-26 |
| Current Penalty | 637.5 |
| Initial Penalty | 1275.0 |
| Nr Instances | 1 |
| Nr Exposed | 1 |
| Gravity | 01 |
| Citation ID | 01003A |
| Citaton Type | Serious |
| Standard Cited | 19101030 C01 IIA |
| Issuance Date | 2008-12-17 |
| Abatement Due Date | 2008-12-25 |
| Current Penalty | 637.5 |
| Initial Penalty | 1275.0 |
| Nr Instances | 1 |
| Nr Exposed | 175 |
| Gravity | 01 |
| Citation ID | 01003B |
| Citaton Type | Serious |
| Standard Cited | 19101030 C01 IIB |
| Issuance Date | 2008-12-17 |
| Abatement Due Date | 2008-12-26 |
| Nr Instances | 1 |
| Nr Exposed | 175 |
| Gravity | 01 |
| Citation ID | 01003C |
| Citaton Type | Serious |
| Standard Cited | 19101030 C01 IIC |
| Issuance Date | 2008-12-17 |
| Abatement Due Date | 2008-12-26 |
| Nr Instances | 1 |
| Nr Exposed | 175 |
| Gravity | 01 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
