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  5. Scalabrini Villa, Inc.

Scalabrini Villa, Inc.

Headquarter

Company Details

Name: Scalabrini Villa, Inc.
Jurisdiction: Rhode Island
Entity type: Domestic Non-Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 18 Aug 1989 (35 years ago)
Identification Number: 000057111
ZIP code: 02852
County: Washington County
Principal Address: 860 NORTH QUIDNESSETT RD, NORTH KINGSTOWN, RI, 02852, USA
Purpose: TO MAINTAIN A NURSING HOME
NAICS: 622110 - General Medical and Surgical Hospitals

Links between entities

Type Company Name Company Number State
Headquarter of Scalabrini Villa, Inc., ILLINOIS CORP_55994811 ILLINOIS

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1437157898 2005-07-11 2007-08-03 860 N QUIDNESSETT RD, NORTH KINGSTOWN, RI, 028521000, US 860 N QUIDNESSETT RD, NORTH KINGSTOWN, RI, 028521000, US

Contacts
Phone +1 401-884-1802
Fax 4018844727

Authorized person
Name JOY RYAN
Role ADMINISTRATOR
Phone 4018841802

Taxonomy
Taxonomy Code 314000000X - Skilled Nursing Facility
License Number LTC00367
State RI
Is Primary Yes

Other Provider Identifiers
Issuer BLUE CROSS & BLUE SHIELD
Number 5003
State RI
Issuer MEDICAID
Number 4105063
State RI
Issuer UNITED HEALTHCARE OF NE
Number 71-07104
State RI
Issuer BLUE CHIP OF RI
Number 40-2433
State RI
Issuer UNITED HEALTH - EVERCARE
Number 71-01149
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SCALABRINI VILLA 401K PLAN 2021 050449292 2022-03-17 SCALABRINI VILLA, INC. 73
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 623000
Sponsor’s telephone number 4018841802
Plan sponsor’s address 860 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852
SCALABRINI VILLA 401K PLAN 2020 050449292 2021-04-07 SCALABRINI VILLA, INC. 88
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 623000
Sponsor’s telephone number 4018841802
Plan sponsor’s address 860 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852
SCALABRINI VILLA 401K PLAN 2019 050449292 2020-05-19 SCALABRINI VILLA, INC. 106
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 623000
Sponsor’s telephone number 4018841802
Plan sponsor’s address 860 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852
SCALABRINI VILLA 401K PLAN 2018 050449292 2019-04-23 SCALABRINI VILLA, INC. 88
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 623000
Sponsor’s telephone number 4018841802
Plan sponsor’s address 860 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852
SCALABRINI VILLA 401K PLAN 2017 050449292 2018-04-25 SCALABRINI VILLA, INC. 99
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 623000
Sponsor’s telephone number 4018841802
Plan sponsor’s address 860 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852
SCALABRINI VILLA 401K PLAN 2016 050449292 2017-07-05 SCALABRINI VILLA, INC. 86
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 623000
Sponsor’s telephone number 4018841802
Plan sponsor’s address 860 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852
SCALABRINI VILLA 401K PLAN 2015 050449292 2016-06-13 SCALABRINI VILLA, INC. 84
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 623000
Sponsor’s telephone number 4018841802
Plan sponsor’s address 860 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852
SCALABRINI VILLA 401K PLAN 2014 050449292 2015-08-26 SCALABRINI VILLA 88
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 623000
Sponsor’s telephone number 4018841802
Plan sponsor’s address 86 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852

Plan administrator’s name and address
Administrator’s EIN 050449292
Plan administrator’s name SCALABRINI VILLA
Plan administrator’s address 86 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852
Administrator’s telephone number 4018841802

Signature of
Role Plan administrator
Date 2015-08-26
Name of individual signing JOY RYAN
Valid signature Filed with authorized/valid electronic signature
SCALABRINI VILLA 401K PLAN 2013 050449292 2014-04-02 SCALABRINI VILLA 101
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 623000
Sponsor’s telephone number 4018841802
Plan sponsor’s address 86 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852

Plan administrator’s name and address
Administrator’s EIN 050449292
Plan administrator’s name SCALABRINI VILLA
Plan administrator’s address 86 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852
Administrator’s telephone number 4018841802

Signature of
Role Plan administrator
Date 2014-04-02
Name of individual signing JOY RYAN
Valid signature Filed with authorized/valid electronic signature
SCALABRINI VILLA 401K PLAN 2012 050449292 2013-07-09 SCALABRINI VILLA 102
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 623000
Sponsor’s telephone number 4018841802
Plan sponsor’s address 86 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852

Plan administrator’s name and address
Administrator’s EIN 050449292
Plan administrator’s name SCALABRINI VILLA
Plan administrator’s address 86 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852
Administrator’s telephone number 4018841802

Signature of
Role Plan administrator
Date 2013-07-09
Name of individual signing JOY RYAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/06/07/20120607195031P030002861222001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 623000
Sponsor’s telephone number 4018841802
Plan sponsor’s address 86 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852

Plan administrator’s name and address
Administrator’s EIN 050449292
Plan administrator’s name SCALABRINI VILLA
Plan administrator’s address 86 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852
Administrator’s telephone number 4018841802

Signature of
Role Plan administrator
Date 2012-06-07
Name of individual signing JOY RYAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/06/08/20110608075616P040002248947001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 623000
Sponsor’s telephone number 4018841802
Plan sponsor’s address 86 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852

Plan administrator’s name and address
Administrator’s EIN 050449292
Plan administrator’s name SCALABRINI VILLA
Plan administrator’s address 86 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852
Administrator’s telephone number 4018841802

Signature of
Role Plan administrator
Date 2011-06-08
Name of individual signing JOY RYAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/06/22/20100622202618P040032566419001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 623000
Sponsor’s telephone number 4018841802
Plan sponsor’s address 86 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852

Plan administrator’s name and address
Administrator’s EIN 050449292
Plan administrator’s name SCALABRINI VILLA
Plan administrator’s address 86 NORTH QUIDNESSETT ROAD, NORTH KINGSTOWN, RI, 02852
Administrator’s telephone number 4018841802

Signature of
Role Plan administrator
Date 2010-06-22
Name of individual signing JOY RYAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
FELIMON RODRIGUEZ SIXTOS Agent 297 LAUREL HILL AVENUE, PROVIDENCE, RI, 02909, USA

PRESIDENT

Name Role Address
REV. HORECIO CARLOS ANKLAN CS PRESIDENT 27 CARMINE STREET NEW YORK, NY 10014 USA

TREASURER

Name Role Address
REV. SERGIO DALLAGNESE CS TREASURER 27 CARMINE STREET NEW YORK, NY 10014 USA

SECRETARY

Name Role Address
REV. JEFFERSON ORLANDO BARIVIERA CS SECRETARY 27 CARMINE STREET NEW YORK, NY 10014 USA

VICE PRESIDENT

Name Role Address
REV. RUBENS SYLVAIN CS VICE PRESIDENT 27 CARMINE STREET NEW YORK, NY 10014 USA

DIRECTOR

Name Role Address
REV. SERGIO DALLAGNESE CS DIRECTOR 27 CARMINE STREET NEW YORK, NY 10014 USA
REV. MAURIZIO MAIFREDI CS DIRECTOR 27 CARMINE STREET NEW YORK, NY 10014 USA
REV. HORECIO CARLOS ANKLAN CS DIRECTOR 27 CARMINE STREET NEW YORK, NY 10014 USA
REV. RUBENS SYLVAIN CS DIRECTOR 27 CARMINE STREET NEW YORK, NY 10014 USA
REV. JEFFERSON ORLANDO BARIVIERA CS DIRECTOR 27 CARMINE STREET NEW YORK, NY 10014 USA

Filings

Number Name File Date
202452374810 Annual Report 2024-04-24
202339424290 Annual Report 2023-07-12
202339414020 Statement of Change of Registered/Resident Agent 2023-07-12
202338426970 Revocation Notice For Failure to File An Annual Report 2023-06-20
202211334990 Statement of Change of Registered/Resident Agent 2022-02-22
202209306280 Annual Report 2022-02-03
202199504130 Annual Report - Amended 2021-07-23
202198803270 Annual Report 2021-06-29
202045986440 Annual Report 2020-07-22
201998312560 Annual Report 2019-06-21

Related by officers

FELIMON RODRIGUEZ SIXTOS

The Pious Society of the Missionaries of St. Charles Boromeo, Inc. Blessed John Baptist Scalabrini Residence, Inc.

REV. HORECIO CARLOS ANKLAN CS

The Pious Society of the Missionaries of St. Charles Boromeo, Inc. Blessed John Baptist Scalabrini Residence, Inc.

REV. SERGIO DALLAGNESE CS

The Pious Society of the Missionaries of St. Charles Boromeo, Inc. Blessed John Baptist Scalabrini Residence, Inc.

REV. JEFFERSON ORLANDO BARIVIERA CS

The Pious Society of the Missionaries of St. Charles Boromeo, Inc. Blessed John Baptist Scalabrini Residence, Inc.

REV. RUBENS SYLVAIN CS

The Pious Society of the Missionaries of St. Charles Boromeo, Inc. Blessed John Baptist Scalabrini Residence, Inc.

REV. MAURIZIO MAIFREDI CS

The Pious Society of the Missionaries of St. Charles Boromeo, Inc. Blessed John Baptist Scalabrini Residence, Inc.

Related by address

860 NORTH QUIDNESSETT RD, NORTH KINGSTOWN, RI, 02852, USA

Blessed John Baptist Scalabrini Residence, Inc.

Date of last update: 07 Oct 2024

Sources: Rhode Island Department of State

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