| 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: | 02886 |
| County: | Kent County |
| Principal Address: | 2364 POST ROAD SUITE 100, WARWICK, RI, 02886, USA |
| Purpose: | OPERATING A NURSING AND CONVALESCENT HOME |
| Historical names: |
St. Elizabeth Acquisition Corp. Metacom Manor Health Center |
NAICS
623110 Nursing Care Facilities (Skilled Nursing Facilities)This industry comprises establishments primarily engaged in providing inpatient nursing and rehabilitative services. The care is generally provided for an extended period of time to individuals requiring nursing care. These establishments have a permanent core staff of registered or licensed practical nurses who, along with other staff, provide nursing and continuous personal care services. Learn more at the U.S. Census Bureau
| 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 |
| 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 |
| KRISTEN L. DISANTO | DIRECTOR | 23 BROAD ST. WESTERLY, RI 02891 USA |
| KIMBERLEY RANALLI | DIRECTOR | 100 SOCKANOSSET CROSSROAD, RDC170 CRANSTON, RI 02920 USA |
| PHILIP C. SLOCUM | DIRECTOR | 211 CARLTON AVE. WARWICK, RI 02889 USA |
| STEVEN W. TILLEY | DIRECTOR | 602 EAST SHORE RD JAMESTOWN, RI 02835 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: 08 Apr 2025
Sources: Rhode Island Department of State
