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PACE Organization of Rhode Island

Company Details

Name: PACE Organization of Rhode Island
Jurisdiction: Rhode Island
Entity type: Domestic Non-Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 27 Aug 2004 (20 years ago)
Identification Number: 000142328
ZIP code: 02915
County: Providence County
Principal Address: 10 TRIPPS LANE, RIVERSIDE, RI, 02915, USA
Purpose: TO PROVIDE CARE AND SERVICES TO THE ELDERLY
NAICS: 624120 - Services for the Elderly and Persons with Disabilities
Fictitious names: Savory Fare (trading name, 2023-04-26 - 2023-05-02)
PACE-RI (trading name, 2022-06-01 - )
Adult Day Center of Westerly (trading name, 2013-07-01 - )
Pace Organization of Rhode Island (trading name, 2005-04-13 - )
Historical names: CareLink Pace Organization
Pace Organization of Rhode Island

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1083690044 2005-12-21 2024-07-09 10 TRIPPS LANE, RIVERSIDE, RI, 02915, US 10 TRIPPS LANE, RIVERSIDE, RI, 02915, US

Contacts

Phone +1 401-654-4789
Fax 4016544660

Authorized person

Name CRAIG MCANAUGH
Role CFO
Phone 4014341400

Taxonomy

Taxonomy Code 251E00000X - Home Health Agency
Is Primary No
Taxonomy Code 261QA0600X - Adult Day Care Clinic/Center
Is Primary No
Taxonomy Code 302F00000X - Exclusive Provider Organization
License Number 19
State RI
Is Primary Yes

Other Provider Identifiers

Issuer PACE DHS CONTRACT #
Number H4105

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PACE ORGANIZATION OF RI 403(B) PLAN 2023 300297335 2024-05-17 PACE ORGANIZATION OF RHODE ISLAND 174
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 524140
Sponsor’s telephone number 4014341400
Plan sponsor’s address 10 TRIPPS LANE, RIVERSIDE, RI, 029153014

Signature of

Role Plan administrator
Date 2024-05-17
Name of individual signing CRAIG MCANAUGH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-05-17
Name of individual signing CRAIG MCANAUGH
Valid signature Filed with authorized/valid electronic signature
PACE ORGANIZATION OF RHODE ISLAND BENEFITS PLAN 2017 300297335 2018-07-30 PACE ORGANIZATION OF RHODE ISLAND 159
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2016-01-01
Business code 624100
Sponsor’s telephone number 4014906566
Plan sponsor’s mailing address 225 CHAPMAN ST, PROVIDENCE, RI, 02905
Plan sponsor’s address 225 CHAPMAN ST, PROVIDENCE, RI, 02905

Number of participants as of the end of the plan year

Active participants 172

Signature of

Role Plan administrator
Date 2018-07-30
Name of individual signing LYNDA GILBERT
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JOAN KWIATKOWSKI Agent 10 TRIPPS LANE, RIVERSIDE, RI, 02915, USA

DIRECTOR

Name Role Address
JAYNE PAWASAUSKAS DIRECTOR 65 PARTRIDGE RUN . EAST GREENWICH, RI 02818 USA
MITCHELL WICE DIRECTOR 128 DORSET ROAD WABAN , MA 02468 USA
ELLEN MCCREEDY DIRECTOR 19 TARIS STREET PAWTUCKET, RI 02860 USA
MARIE GANIM DIRECTOR 14 MITRIS BLVD LINCOLN, RI 02865 USA
YASIN ABUL DIRECTOR 12 TOWNSEND ST BARRINGTON, RI 02806 USA
ELLEN MCGOUGH DIRECTOR 25 W INDEPENDENCE WAY KINGSTON, RI 02881 USA
MEGAN HERNE DIRECTOR 35 MADISON ST. WARWICK , RI 02888 USA
CANDIDUS NWAKASI DIRECTOR 25 PAPER CHASE SOUTH WINDSOR, CT 06074 USA
EDWARD DAREZZO DIRECTOR 72 ASHBURTON DRIVE CRANSTON, RI 02921 USA
WHITNEY MILLS DIRECTOR 1402 PINEWOOD DRIVE SMITHFIELD, RI 02917 USA

SECRETARY OF CLERK

Name Role Address
DAVID DEJESUS SECRETARY OF CLERK 222 EDMOUND DR. NORTH KINGSTOWN, RI 02852 USA

TREASURER

Name Role Address
KIM DENNY TREASURER 4 ST. MICHAELS CT. RUMFORD , RI 02916 USA

VICE PRESIDENT

Name Role Address
DALISSA KELLY VICE PRESIDENT 51 WILLOWTREE LANE MIDDLEBORO, MA 02346 USA

PRESIDENT

Name Role Address
DANIELLE KOPF PRESIDENT 3 LAKESIDE DRIVE NARRAGANSETT, RI 02882 USA

Events

Type Date Old Value New Value
Name Change 2017-01-18 Pace Organization of Rhode Island PACE Organization of Rhode Island
Name Change 2017-01-17 CareLink Pace Organization Pace Organization of Rhode Island
Merged 2013-07-01 Adult Day Center of Westerly Inc. on PACE Organization of Rhode Island

Filings

Number Name File Date
202445532760 Annual Report 2024-02-05
202335141010 Statement of Abandonment of Use of Fictitious Business Name 2023-05-02
202334102760 Fictitious Business Name Statement 2023-04-26
202327080590 Annual Report 2023-02-01
202218070710 Fictitious Business Name Statement 2022-06-01
202213295460 Annual Report 2022-03-23
202107282910 Statement of Change of Registered/Resident Agent Office 2021-12-20
202198071480 Annual Report 2021-06-09
202043212190 Annual Report 2020-06-24
201993872870 Annual Report 2019-05-22

Date of last update: 09 Oct 2024

Sources: Rhode Island Department of State