| 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 Facilities |
| 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 CARVALHO | Agent | 3709 MAIN ROAD, TIVERTON, RI, 02878, USA |
| 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 |
| 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: 07 Oct 2024
Sources: Rhode Island Department of State
