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  5. CHARLESGATE NURSING CENTER

CHARLESGATE NURSING CENTER

Company Details

Name: CHARLESGATE NURSING CENTER
Jurisdiction: Rhode Island
Entity type: Domestic Limited Partnership
Status: Activ
Date of Organization in Rhode Island: 31 Dec 1975 (49 years ago)
Identification Number: 000049120
ZIP code: 02904
County: Providence County
Principal Address: C/O DAVENPORT ASSOCIATES LTD. 50 RANDALL STREET, PROVIDENCE, RI, 02904, USA
Mailing Address: C/O DAVENPORT ASSOCIATES LTD. 670 NORTH MAIN STREET, PROVIDENCE, RI, 02904, USA
Purpose: FORMER NURSING HOME, NOW LEASING SPACE FOR HOMELESS ORGANIZATIONS AND ADDITION REHAB.

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1881684736 2005-10-24 2008-04-10 100 RANDALL ST, PROVIDENCE, RI, 029042723, US 100 RANDALL ST, PROVIDENCE, RI, 029042723, US

Contacts
Phone +1 401-861-5858
Fax 4018612540

Authorized person
Name MISS LUCILLE MASSEMINO
Role ADMINISTRATOR
Phone 4018615858

Taxonomy
Taxonomy Code 314000000X - Skilled Nursing Facility
License Number LTC00621
State RI
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 4105052
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CHARLESGATE NURSING CENTER 401(K)PLAN FOR UNION EMPLOYEES 2023 050367730 2024-09-23 CHARLESGATE NURSING CENTER 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2000-03-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2024-09-23
Name of individual signing NEIL SHUNNEY
Valid signature Filed with authorized/valid electronic signature
CHARLESGATE NURSING CENTER 401(K)PLAN FOR UNION EMPLOYEES 2023 050367730 2024-09-23 CHARLESGATE NURSING CENTER 61
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2000-03-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2024-09-23
Name of individual signing NEIL SHUNNEY
Valid signature Filed with authorized/valid electronic signature
CHARLESGATE NURSING CENTER 401(K)PLAN FOR MANAGEMENT EMPLOYEES 2023 050367730 2024-09-23 CHARLESGATE NURSING CENTER 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2024-09-23
Name of individual signing NEIL SHUNNEY
Valid signature Filed with authorized/valid electronic signature
CHARLESGATE NURSING CENTER 401(K)PLAN FOR MANAGEMENT EMPLOYEES 2023 050367730 2024-09-23 CHARLESGATE NURSING CENTER 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2024-09-23
Name of individual signing NEIL SHUNNEY
Valid signature Filed with authorized/valid electronic signature
CHARLESGATE NURSING CENTER 401(K)PLAN FOR UNION EMPLOYEES 2022 050367730 2023-09-22 CHARLESGATE NURSING CENTER 72
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2000-03-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2023-09-22
Name of individual signing NEIL SHUNNEY
Valid signature Filed with authorized/valid electronic signature
CHARLESGATE NURSING CENTER 401(K)PLAN FOR MANAGEMENT EMPLOYEES 2022 050367730 2023-09-22 CHARLESGATE NURSING CENTER 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2023-09-22
Name of individual signing NEIL SHUNNEY
Valid signature Filed with authorized/valid electronic signature
CHARLESGATE NURSING CENTER 401(K)PLAN FOR UNION EMPLOYEES 2021 050367730 2022-09-26 CHARLESGATE NURSING CENTER 85
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2000-03-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2022-09-26
Name of individual signing KAREN L LALLY
Valid signature Filed with authorized/valid electronic signature
CHARLESGATE NURSING CENTER 401(K)PLAN FOR MANAGEMENT EMPLOYEES 2021 050367730 2022-09-26 CHARLESGATE NURSING CENTER 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2022-09-26
Name of individual signing KAREN L LALLY
Valid signature Filed with authorized/valid electronic signature
CHARLESGATE NURSING CENTER 401(K)PLAN FOR MANAGEMENT EMPLOYEES 2020 050367730 2021-05-17 CHARLESGATE NURSING CENTER 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2021-05-17
Name of individual signing KAREN LALLY
Valid signature Filed with authorized/valid electronic signature
CHARLESGATE NURSING CENTER 401(K)PLAN FOR UNION EMPLOYEES 2020 050367730 2021-05-17 CHARLESGATE NURSING CENTER 97
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2000-03-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2021-05-17
Name of individual signing KAREN LALLY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2020/05/11/20200511112452NAL0021613232001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2000-03-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2020-05-11
Name of individual signing KAREN LALLY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2020/05/11/20200511112325NAL0021611328001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2020-05-11
Name of individual signing KAREN LALLY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2019/06/04/20190604131302P040204500541001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2019-06-04
Name of individual signing KAREN LALLY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2018/07/18/20180718163054P030003086149001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2018-07-18
Name of individual signing KAREN LALLY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/06/06/20170606090214P040061617857001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2017-06-06
Name of individual signing KAREN LALLY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/10/11/20161011162700P040001059877001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2016-10-11
Name of individual signing KAREN LALLY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/07/13/20150713170821P030095154407001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2015-07-13
Name of individual signing KAREN LALLY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/10/14/20141014144243P030019990477001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing KAREN LALLY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/15/20130715150245P040016978160001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2013-07-15
Name of individual signing KAREN LALLY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/08/08/20120808133735P040025923634001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904

Plan administrator’s name and address
Administrator’s EIN 050367730
Plan administrator’s name CHARLESGATE NURSING CENTER
Plan administrator’s address 100 RANDALL STREET, PROVIDENCE, RI, 02904
Administrator’s telephone number 4018615858

Signature of
Role Plan administrator
Date 2012-08-08
Name of individual signing KAREN LALLY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/08/25/20110825144925P030017351090001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 623000
Sponsor’s telephone number 4018615858
Plan sponsor’s address 100 RANDALL STREET, PROVIDENCE, RI, 029042723

Plan administrator’s name and address
Administrator’s EIN 050367730
Plan administrator’s name CHARLESGATE NURSING CENTER
Plan administrator’s address 100 RANDALL STREET, PROVIDENCE, RI, 029042723
Administrator’s telephone number 4018615858

Signature of
Role Plan administrator
Date 2011-08-25
Name of individual signing KAREN LALLY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
NEIL SHUNNEY Agent 50 RANDALL STREET, PROVIDENCE, RI, 02904, USA

Filings

Number Name File Date
202453330310 Annual Report 2024-04-30
202342983520 Statement of Change of Registered/Resident Agent 2023-11-28
201183401530 Certificate of Amendment to Certificate of Limited Partnership 2011-09-23
201181088940 Certificate of Amendment to Certificate of Limited Partnership 2002-11-22
201181088850 Certificate of Amendment to Certificate of Limited Partnership 1997-07-25
201181089000 Certificate of Amendment to Certificate of Limited Partnership 1981-09-24
201181089190 Certificate of Amendment to Certificate of Limited Partnership 1976-12-24
201181089280 Certificate of Amendment to Certificate of Limited Partnership 1976-04-23
201181089370 Certificate of Limited Partnership 1975-12-31

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
345704597 0112300 2021-12-30 100 RANDALL STREET, PROVIDENCE, RI, 02904
Inspection Type Complaint
Scope Partial
Safety/Health Health
Close Conference 2021-12-30
Emphasis N: COVID-19
Case Closed 2022-08-30

Related Activity
Type Complaint
Activity Nr 1846627
Health Yes

Violation Items
Citation ID 01001A
Citaton Type Serious
Standard Cited 19100134 C01
Issuance Date 2022-06-09
Abatement Due Date 2022-07-27
Current Penalty 6712.2
Initial Penalty 7458.0
Final Order 2022-07-01
Nr Instances 1
Nr Exposed 117
Related Event Code (REC) Complaint
Gravity 5
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.134(c)(1): A written respiratory protection program that included the provisions in 29 CFR 1910.134(c)(1)(i) - (ix) with worksite specific procedures was not established and implemented for required respirator use: (a) Facility: On or about December 30, 2021, the written respiratory protection program addressing the provisions in 29 CFR 1910.134(c)(1)(i) - (ix) was not implemented to ensure employee protection from exposure to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) in that employees were not provided medical evaluations and fit-testing prior to required use of N95 respirators while providing direct care to suspect or confirmed COVID-19 residents.
Citation ID 01001B
Citaton Type Serious
Standard Cited 19100134 E01
Issuance Date 2022-06-09
Abatement Due Date 2022-07-27
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2022-07-01
Nr Instances 1
Nr Exposed 117
Gravity 1
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.134(e)(1): The employer did not provide a medical evaluation to determine the employee's ability to use a respirator before the employee was fit-tested or required to use the respirator in the workplace: (a) Facility-wide: On or about 12/30/2021, where N95 filtering face piece respirators were required to be worn by employees exposed to the SARS-CoV-2 virus while providing care to presumed and confirmed COVID-19 positive residents, and all other employees including administrative staff, medical evaluations were not provided.
Citation ID 01001C
Citaton Type Serious
Standard Cited 19100134 F02
Issuance Date 2022-06-09
Abatement Due Date 2022-07-27
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2022-07-01
Nr Instances 1
Nr Exposed 117
Gravity 5
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.134(f)(2):Employee(s) using tight-fitting facepiece respirators were not fit-tested prior to initial use of the respirator: (a) Facility-wide: On or about 12/30/2021, where N95 filtering face piece respirators were required to be worn by employees exposed to the SARS-CoV-2 virus while providing care to presumed and confirmed COVID19 positive residents, and all other employees including administrative staff, fit-testing was not provided prior to use.
310156898 0112300 2007-06-14 100 RANDALL STREET, PROVIDENCE, RI, 02904
Inspection Type Prog Other
Scope Partial
Safety/Health Safety
Close Conference 2007-12-04
Case Closed 2007-12-04
307570499 0112300 2004-09-15 100 RANDALL STREET, PROVIDENCE, RI, 02904
Inspection Type Complaint
Scope Partial
Safety/Health Safety
Close Conference 2004-09-15
Case Closed 2004-09-21

Related Activity
Type Complaint
Activity Nr 204878441
Safety Yes
304992233 0112300 2003-05-22 100 RANDALL STREET, PROVIDENCE, RI, 02904
Inspection Type Planned
Scope Partial
Safety/Health Health
Close Conference 2003-06-19
Emphasis N: NURSING, S: NURSING HOMES
Case Closed 2003-08-11

Violation Items
Citation ID 01001A
Citaton Type Other
Standard Cited 19101030 C01 I
Issuance Date 2003-06-20
Abatement Due Date 2003-08-07
Nr Instances 1
Nr Exposed 6
Gravity 01
Citation ID 01001B
Citaton Type Other
Standard Cited 19101030 G02 I
Issuance Date 2003-06-20
Abatement Due Date 2003-08-07
Nr Instances 3
Nr Exposed 2
Gravity 01
300098670 0112300 1998-10-14 100 RANDALL STREET, PROVIDENCE, RI, 02904
Inspection Type Planned
Scope Complete
Safety/Health Safety
Close Conference 1999-02-02
Emphasis L: XEISA, N: GSINTARG, S: NURSING HOMES
Case Closed 1999-03-03

Violation Items
Citation ID 01001
Citaton Type Serious
Standard Cited 19100212 A01
Issuance Date 1999-02-03
Abatement Due Date 1999-03-02
Current Penalty 550.0
Initial Penalty 1100.0
Nr Instances 1
Nr Exposed 5
Gravity 02
Citation ID 01002
Citaton Type Serious
Standard Cited 19100305 E01
Issuance Date 1999-02-03
Abatement Due Date 1999-03-02
Current Penalty 550.0
Initial Penalty 1100.0
Nr Instances 1
Nr Exposed 5
Gravity 02
Citation ID 02001
Citaton Type Other
Standard Cited 19100305 B02
Issuance Date 1999-02-03
Abatement Due Date 1999-03-02
Nr Instances 1
Nr Exposed 1
Gravity 01
Citation ID 02002
Citaton Type Other
Standard Cited 19100305 G02 III
Issuance Date 1999-02-03
Abatement Due Date 1999-03-02
Nr Instances 1
Nr Exposed 5
Gravity 01
300098563 0112300 1998-09-28 100 RANDALL STREET, PROVIDENCE, RI, 02904
Inspection Type Planned
Scope Complete
Safety/Health Health
Close Conference 1999-02-02
Emphasis N: GSINTARG
Case Closed 1999-03-03

Violation Items
Citation ID 01001A
Citaton Type Serious
Standard Cited 19101030 D04 IIIA2
Issuance Date 1999-02-03
Abatement Due Date 1999-03-02
Current Penalty 687.5
Initial Penalty 1375.0
Nr Instances 1
Nr Exposed 2
Gravity 03
Citation ID 01001B
Citaton Type Serious
Standard Cited 19101030 G02 IIC
Issuance Date 1999-02-03
Abatement Due Date 1999-03-09
Nr Instances 1
Nr Exposed 4
Gravity 03

Related by officers

NEIL SHUNNEY

Davenport Associates, Ltd. CG PARK CORP. CG SOUTH CORP. CG EAST CORP. RHODE ISLAND ASSISTED LIVING MANAGEMENT, LLC PARKIS PARTNERS, LLC CGP, LLC CGS, LLC CGE, LLC DAVENPORT ASSOCIATES DEVELOPMENT, LLC

Related by address

No related companies by address

Date of last update: 07 Apr 2025

Sources: Rhode Island Department of State

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