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  5. SHORELINE NEPHROLOGY ASSOCIATES, INC.

SHORELINE NEPHROLOGY ASSOCIATES, INC.

Company Details

Name: SHORELINE NEPHROLOGY ASSOCIATES, INC.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Dissolved
Date of Organization in Rhode Island: 01 Sep 1994 (30 years ago)
Date of Dissolution: 27 Dec 2016 (8 years ago)
Date of Status Change: 27 Dec 2016 (8 years ago)
Identification Number: 000081054
ZIP code: 02891
County: Washington County
Principal Address: 17 WELLS STREET SUITE 202 SUITE 202, WESTERLY, RI, 02891, USA
Purpose: ENGAGING IN THE PRACTICE OF MEDICINE.

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1770665424 2006-10-20 2008-05-19 17 WELLS ST, SUITE 202, WESTERLY, RI, 028912923, US 17 WELLS ST, SUITE 202, WESTERLY, RI, 028912923, US

Contacts
Phone +1 401-596-3313
Fax 4015962650

Authorized person
Name MARK J MANCINI
Role VICE PRESIDENT
Phone 4015963313

Taxonomy
Taxonomy Code 207RN0300X - Nephrology Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 7002051
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SHORELINE NEPHROLOGY ASSOCIATES, INC. PROFIT SHARING PLAN 2013 050479724 2014-11-12 SHORELINE NEPHROLOGY ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1983-01-01
Business code 621111
Sponsor’s telephone number 4015963313
Plan sponsor’s address 17 WELLS STREET, SUITE 202, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2014-11-12
Name of individual signing MARK J MANCINI MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-11-12
Name of individual signing MARK MANCINI MD
Valid signature Filed with authorized/valid electronic signature
SHORELINE NEPHROLOGY ASSOCIATES, INC. PROFIT SHARING PLAN 2013 050479724 2014-05-23 SHORELINE NEPHROLOGY ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1983-01-01
Business code 621111
Sponsor’s telephone number 4015963313
Plan sponsor’s address 17 WELLS STREET, SUITE 202, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2014-05-23
Name of individual signing MARK MANCINI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-05-23
Name of individual signing MARK MANCINI
Valid signature Filed with authorized/valid electronic signature
SHORELINE NEPHROLOGY ASSOCIATES, INC. PROFIT SHARING PLAN 2012 050479724 2013-04-17 SHORELINE NEPHROLOGY ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1983-01-01
Business code 621111
Sponsor’s telephone number 4015963313
Plan sponsor’s address 17 WELLS STREET, SUITE 202, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2013-04-17
Name of individual signing MARK MANCINI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-04-17
Name of individual signing MARK MANCINI
Valid signature Filed with authorized/valid electronic signature
SHORELINE NEPHROLOGY ASSOCIATES, INC. PROFIT SHARING PLAN 2011 050479724 2012-09-23 SHORELINE NEPHROLOGY ASSOCIATES, INC. 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1983-01-01
Business code 621111
Sponsor’s telephone number 4015963313
Plan sponsor’s address 17 WELLS STREET, WESTERLY, RI, 02891

Plan administrator’s name and address
Administrator’s EIN 050479724
Plan administrator’s name SHORELINE NEPHROLOGY ASSOCIATES, INC.
Plan administrator’s address 17 WELLS STREET, WESTERLY, RI, 02891
Administrator’s telephone number 4015963313

Signature of
Role Plan administrator
Date 2012-09-23
Name of individual signing SOMERSET33
Valid signature Filed with authorized/valid electronic signature
SHORELINE NEPHROLOGY ASSOCIATES, INC. PROFIT SHARING PLAN 2010 050479724 2011-09-28 SHORELINE NEPHROLOGY ASSOCIATES, INC. 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1983-01-01
Business code 621111
Sponsor’s telephone number 4015963313
Plan sponsor’s address 17 WELLS STREET, WESTERLY, RI, 02891

Plan administrator’s name and address
Administrator’s EIN 050479724
Plan administrator’s name SHORELINE NEPHROLOGY ASSOCIATES, INC.
Plan administrator’s address 17 WELLS STREET, WESTERLY, RI, 02891
Administrator’s telephone number 4015963313

Signature of
Role Plan administrator
Date 2011-09-28
Name of individual signing MARK J MANCINI MD
Valid signature Filed with authorized/valid electronic signature
SHORELINE NEPHROLOGY ASSOCIATES, INC. PROFIT SHARING PLAN 2009 050479724 2010-09-27 SHORELINE NEPHROLOGY ASSOCIATES, INC. 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1983-01-01
Business code 621111
Sponsor’s telephone number 4015963313
Plan sponsor’s address 17 WELLS STREET, WESTERLY, RI, 02891

Plan administrator’s name and address
Administrator’s EIN 050479724
Plan administrator’s name SHORELINE NEPHROLOGY ASSOCIATES, INC.
Plan administrator’s address 17 WELLS STREET, WESTERLY, RI, 02891
Administrator’s telephone number 4015963313

Signature of
Role Plan administrator
Date 2010-09-27
Name of individual signing MARK MANCINI
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ROBERT M. SERRA Agent 17 WELLS STREET, WESTERLY, RI, 02891, USA

PRESIDENT

Name Role Address
MARK JOSEPH MANCINI MD PRESIDENT 17 WELLS STREET WESTERLY, RI 02891 USA

Filings

Number Name File Date
201629152060 Articles of Dissolution 2016-12-27
201589734700 Annual Report 2015-12-26
201552941140 Annual Report 2015-01-07
201432291080 Annual Report 2014-01-02
201309756690 Annual Report 2013-01-14
201287652540 Annual Report 2012-01-06
201173292500 Annual Report 2011-01-08
201056362180 Annual Report 2010-01-16
200943259110 Annual Report 2009-02-26
200808803050 Annual Report 2008-02-15

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 07 Oct 2024

Sources: Rhode Island Department of State

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