| Name: | FOREST FARM HEALTH CARE CENTER I, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 04 Apr 2003 (22 years ago) |
| Date of Dissolution: | 14 Aug 2018 (6 years ago) |
| Date of Status Change: | 14 Aug 2018 (6 years ago) |
| Identification Number: | 000131086 |
| ZIP code: | 02842 |
| County: | Newport County |
| Principal Address: | 201 FOREST AVENUE, MIDDLETOWN, RI, 02842, USA |
| Mailing Address: | 193 FOREST AVENUE, MIDDLETOWN, RI, 02842, USA |
| Purpose: | MULTI USE BUILDING |
| NAICS: | 531110 - Lessors of Residential Buildings and Dwellings |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184714602 | 2006-10-13 | 2020-08-22 | 201 FOREST AVE, MIDDLETOWN, RI, 028424625, US | 201 FOREST AVE, MIDDLETOWN, RI, 028424625, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 401-847-2777 |
| Fax | 4018487403 |
Authorized person
| Name | MR. KARL H LYON |
| Role | ADMINISTRATOR OWNER |
| Phone | 4018472777 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | ALR01308 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 00737 |
| State | RI |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | FF03657 |
| State | RI |
| Issuer | MEDICAID |
| Number | FF40453 |
| State | RI |
| Issuer | MEDICAID |
| Number | 4105040 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| KARL H. LYON, JR. | Agent | 201 FOREST AVENUE, MIDDLETOWN, RI, 02842, USA |
| Number | Name | File Date |
|---|---|---|
| 201874492740 | Articles of Dissolution | 2018-08-14 |
| 201874492290 | Annual Report | 2018-08-14 |
| 201874491590 | Reinstatement | 2018-08-14 |
| 201873275100 | Revocation Certificate For Failure to File the Annual Report for the Year | 2018-07-30 |
| 201865706010 | Revocation Notice For Failure to File An Annual Report | 2018-05-15 |
| 201609405720 | Annual Report | 2016-09-26 |
| 201582313650 | Annual Report | 2015-10-13 |
| 201446135800 | Annual Report | 2014-09-17 |
| 201435567290 | Annual Report | 2014-02-14 |
| 201433593110 | Revocation Notice For Failure to File An Annual Report | 2014-01-17 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
