| Name: | Saint Elizabeth Manor, East Bay |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Non-Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 10 Dec 1990 (34 years ago) |
| Identification Number: | 000062678 |
| ZIP code: | 02809 |
| County: | Bristol County |
| Principal Address: | ONE DAWN HILL ROAD, BRISTOL, RI, 02809, USA |
| Purpose: | OPERATING A NURSING AND CONVALESCENT HOME |
| NAICS: | 623110 - Nursing Care Facilities (Skilled Nursing Facilities) |
| Historical names: |
St. Elizabeth Acquisition Corp. Metacom Manor Health Center |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659355519 | 2005-12-05 | 2007-08-15 | 1 DAWN HILL RD, BRISTOL, RI, 028093903, US | 1 DAWN HILL RD, BRISTOL, RI, 028093903, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 401-253-2300 |
| Fax | 4012541919 |
Authorized person
| Name | ELIZABETH RUSSELL |
| Role | ADMINISTRATOR |
| Phone | 4012532300 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | LTC00667 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUECHIP PROVIDER NUMBER |
| Number | 402364 |
| State | RI |
| Issuer | BC/BS |
| Number | 50407 |
| State | RI |
| Issuer | MEDICAID |
| Number | 6996931 |
| State | MA |
| Issuer | MEDICAID |
| Number | SE48598 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| SANDRA MATRONE MACK | Agent | 10 WEYBOSSET STREET SUITE 905, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| MATTHEW TRIMBLE | CEO | 2364 POST RD STE 100 WARWICK, RI 02886 USA |
| Name | Role | Address |
|---|---|---|
| STEVEN TILLEY | CHAIR | 602 EAST SHORE RD JAMESTOWN, RI 02835 USA |
| Name | Role | Address |
|---|---|---|
| CLAIRE C. FLAHERTY | VICE CHAIR | 936 BUTTONWOODS AVENUE WARWICK, RI 02886 USA |
| Name | Role | Address |
|---|---|---|
| STEVEN H. KITCHIN | TREASURER | ONE NEW ENGLAND TECH BLVD EAST GREENWICH, RI 02818 USA |
| Name | Role | Address |
|---|---|---|
| JUDY W. VIGAR | SECRETARY | 7 LARCH AVENUE NARRAGANSETT, RI 02882 USA |
| Name | Role | Address |
|---|---|---|
| CRAIG W. CARPENTER | DIRECTOR | 29 SOUTH POND DRIVE COVENTRY, RI 02816 USA |
| MARK J. PROVOST | DIRECTOR | PO BOX 444 EAST GREENWICH, RI 02818 USA |
| PETER HOLLMAN, MD | DIRECTOR | 74 FORT AVE. CRANSTON, RI 02905 USA |
| FREDERICK G. HARRISON | DIRECTOR | 19 CHANNEL VW., UNIT 2 WARWICK, RI 02889 USA |
| SCOTT SEABACK | DIRECTOR | 56 MAPLE STREET WARWICK, RI 02886 USA |
| ROBIN DZIUBA | DIRECTOR | ONE CITIZENS PLAZA, SUITE 1000 PROVIDENCE, RI 02903 USA |
| TIMOTHY MURRAY | DIRECTOR | 221 BROADWAY PROVIDENCE, RI 02903 USA |
| E. PAUL LARRAT, PH.D. R.PH. | DIRECTOR | 853 GILBERT STUART RD. SAUNDERSTOWN, RI 02874 USA |
| KRISTEN L. DISANTO | DIRECTOR | 23 BROAD ST. WESTERLY, RI 02891 USA |
| KIMBERLEY RANALLI | DIRECTOR | 100 SOCKANOSSET CROSSROAD, RDC170 CRANSTON, RI 02920 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2003-03-07 | Metacom Manor Health Center | Saint Elizabeth Manor, East Bay |
| Name Change | 1991-01-11 | St. Elizabeth Acquisition Corp. | Metacom Manor Health Center |
| Number | Name | File Date |
|---|---|---|
| 202447561290 | Annual Report - Amended | 2024-02-29 |
| 202447385760 | Annual Report | 2024-02-27 |
| 202335934900 | Statement of Change of Registered/Resident Agent | 2023-05-22 |
| 202334976820 | Annual Report | 2023-05-01 |
| 202215498850 | Annual Report | 2022-04-22 |
| 202103638900 | Annual Report | 2021-10-21 |
| 202101356400 | Revocation Notice For Failure to File An Annual Report | 2021-09-13 |
| 202078419180 | Annual Report - Amended | 2020-12-03 |
| 202042139740 | Annual Report | 2020-06-12 |
| 201903327340 | Annual Report | 2019-07-11 |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 302670583 | 0112300 | 2001-01-03 | 1 DAWN HILL ROAD, BRISTOL, RI, 02809 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Citation ID | 01001A |
| Citaton Type | Serious |
| Standard Cited | 19100305 J02 II |
| Issuance Date | 2001-02-13 |
| Abatement Due Date | 2001-03-19 |
| Current Penalty | 550.0 |
| Initial Penalty | 1100.0 |
| Nr Instances | 4 |
| Nr Exposed | 12 |
| Gravity | 02 |
| Citation ID | 01001B |
| Citaton Type | Serious |
| Standard Cited | 19100303 F |
| Issuance Date | 2001-02-13 |
| Abatement Due Date | 2001-02-16 |
| Nr Instances | 1 |
| Nr Exposed | 3 |
| Gravity | 02 |
| Citation ID | 01001C |
| Citaton Type | Serious |
| Standard Cited | 19100305 B01 |
| Issuance Date | 2001-02-13 |
| Abatement Due Date | 2001-03-19 |
| Nr Instances | 1 |
| Nr Exposed | 2 |
| Gravity | 02 |
| Citation ID | 01002A |
| Citaton Type | Serious |
| Standard Cited | 19101030 D02 I |
| Issuance Date | 2001-02-13 |
| Abatement Due Date | 2001-02-16 |
| Current Penalty | 687.5 |
| Initial Penalty | 1375.0 |
| Nr Instances | 1 |
| Nr Exposed | 7 |
| Gravity | 03 |
| Citation ID | 01002B |
| Citaton Type | Serious |
| Standard Cited | 19101030 G02 VIIK |
| Issuance Date | 2001-02-13 |
| Abatement Due Date | 2001-03-19 |
| Nr Instances | 2 |
| Nr Exposed | 4 |
| Gravity | 03 |
| Citation ID | 01002C |
| Citaton Type | Serious |
| Standard Cited | 19101030 F05 |
| Issuance Date | 2001-02-13 |
| Abatement Due Date | 2001-02-16 |
| Nr Instances | 2 |
| Nr Exposed | 6 |
| Gravity | 03 |
| Citation ID | 02001 |
| Citaton Type | Other |
| Standard Cited | 19100101 B |
| Issuance Date | 2001-02-13 |
| Abatement Due Date | 2001-02-16 |
| Nr Instances | 1 |
| Nr Exposed | 7 |
| Gravity | 01 |
| Citation ID | 02002 |
| Citaton Type | Other |
| Standard Cited | 19100147 C04 II |
| Issuance Date | 2001-02-13 |
| Abatement Due Date | 2001-03-19 |
| Nr Instances | 1 |
| Nr Exposed | 2 |
| Gravity | 01 |
| Citation ID | 02003 |
| Citaton Type | Other |
| Standard Cited | 19101200 G08 |
| Issuance Date | 2001-02-13 |
| Abatement Due Date | 2001-03-19 |
| Nr Instances | 2 |
| Nr Exposed | 5 |
| Gravity | 01 |
Date of last update: 07 Oct 2024
Sources: Rhode Island Department of State
