| Name: | ROCKY KNOLL GROUP HOME INC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 15 Nov 1991 (33 years ago) |
| Date of Dissolution: | 30 Dec 2020 (4 years ago) |
| Date of Status Change: | 30 Dec 2020 (4 years ago) |
| Identification Number: | 000066125 |
| ZIP code: | 02878 |
| County: | Newport County |
| Principal Address: | 3709 MAIN ROAD, TIVERTON, RI, 02878, USA |
| Purpose: | WAIVER GROUP HOME FOR DEVELOPMENTALLY DISABLED |
NAICS
623210 Residential Intellectual and Developmental Disability FacilitiesThis industry comprises establishments (e.g., group homes, hospitals, intermediate care facilities) primarily engaged in providing residential care services for persons diagnosed with intellectual and developmental disabilities. These facilities may provide some health care, though the focus is room, board, protective supervision, and counseling. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982735247 | 2007-03-08 | 2011-07-08 | 3709 MAIN RD, TIVERTON, RI, 028784854, US | 3709 MAIN RD, TIVERTON, RI, 028784854, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 401-624-6359 |
| Fax | 4016248383 |
Authorized person
| Name | NANCY M CARVALHO |
| Role | ADMINISTRATOR |
| Phone | 4016246359 |
Taxonomy
| Taxonomy Code | 251C00000X - Developmentally Disabled Services Day Training Agency |
| License Number | 7 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 313M00000X - Nursing Facility/Intermediate Care Facility |
| License Number | 7 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | RK61536 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| NANCY M CARVALHO | PRESIDENT | 3715 MAIN ROAD TIVERTON, RI 02878 USA |
| Name | Role | Address |
|---|---|---|
| DONNA M M GOULET-TRUPPI | TREASURER | 408 EIGHT ROD WAY TIVERTON, RI 02878 USA |
| Name | Role | Address |
|---|---|---|
| NANCY M CARVALHO | SECRETARY | 3715 MAIN ROAD TIVERTON, RI 02878 USA |
| Name | Role | Address |
|---|---|---|
| DONNA M M GOULET-TRUPPI 10/01/1990 | VICE PRESIDENT | 3709 MAIN ROAD TIVERTON, RI 02878 USA |
| Name | Role | Address |
|---|---|---|
| DONNA GOULET -TRUPPI | OTHER OFFICER | 3709 MAIN ROAD TIVERTON, RI 02878 USA |
| Name | Role | Address |
|---|---|---|
| NORMAN COMBRA JR | DIRECTOR | 89 HAMBLY ROAD TIVERTON, RI 02878 USA |
| Name | Role | Address |
|---|---|---|
| NANCY CARVALHO | Agent | 3709 MAIN ROAD, TIVERTON, RI, 02878, USA |
| Number | Name | File Date |
|---|---|---|
| 202082826620 | Revocation Certificate For Failure to File the Annual Report for the Year | 2020-12-30 |
| 202054975820 | Revocation Notice For Failure to File An Annual Report | 2020-09-16 |
| 201984401090 | Annual Report | 2019-01-15 |
| 201858350150 | Annual Report | 2018-02-15 |
| 201737815350 | Annual Report | 2017-03-09 |
| 201589192410 | Annual Report | 2015-12-14 |
| 201552774450 | Annual Report | 2015-01-05 |
| 201432282240 | Annual Report | 2014-01-02 |
| 201310519930 | Annual Report | 2013-01-29 |
| 201288488580 | Annual Report | 2012-01-25 |
Date of last update: 08 Apr 2025
Sources: Rhode Island Department of State
