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642 METACOM AVENUE OPERATIONS LLC

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Company Details

Name: 642 METACOM AVENUE OPERATIONS LLC
Jurisdiction: Rhode Island
Entity type: Foreign Limited Liability Company
Status: Activ
Date of Organization in Rhode Island: 14 Aug 2008 (17 years ago)
Identification Number: 000485359
Place of Formation: DELAWARE
Purpose: OPERATOR OF HEALTHCARE FACILITY
Fictitious names: Warren Skilled Nursing and Rehabilitation (trading name, 2008-08-27 - )
Principal Address: Google Maps Logo 101 EAST STATE STREET, KENNETT SQUARE, PA, 19348, USA
Mailing Address: Google Maps Logo 101 E STATE STREET, KENNETT SQUARE, PA, 19348, USA

Contact Details

Phone +1 401-245-2860

Industry & Business Activity

NAICS

623110 Nursing Care Facilities (Skilled Nursing Facilities)

This industry comprises establishments primarily engaged in providing inpatient nursing and rehabilitative services. The care is generally provided for an extended period of time to individuals requiring nursing care. These establishments have a permanent core staff of registered or licensed practical nurses who, along with other staff, provide nursing and continuous personal care services. Learn more at the U.S. Census Bureau

Agent

Name Role Address
CORPORATION SERVICE COMPANY Agent 222 JEFFERSON BOULEVARD SUITE 200, WARWICK, RI, 02888, USA

Manager

Name Role Address
KEITH NAUSE Manager 101 E STATE STREET KENNETT SQUARE, PA 19348 USA
MICHAEL S SHERMAN Manager 101 E. STATE STREET KENNETT SQUARE, PA 19348 USA
STEPHEN S YOUNG Manager 101 E. STATE STREET KENNETT SQUARE, PA 19348 USA
MICHAEL BERG Manager 101 E. STATE STREET KENNETT SQUARE, PA 19348 USA
SEAN STEVENSON Manager 101 E STATE STREET KENNETT SQUARE, PA 19348 USA

National Provider Identifier

NPI Number:
1265683874
Certification Date:
2024-01-22

Authorized Person:

Name:
MICHAEL T BERG
Role:
ASSISTANT SECRETARY
Phone:

Taxonomy:

Selected Taxonomy:
314000000X - Skilled Nursing Facility
Is Primary:
Yes

Contacts:

Fax:
4012450959

Licenses

License No License Type Status Date Issued Expiration Date
LTC00796 Nursing Facility Active 2015-02-02 2025-12-31
FSV26803 Seats - 50 or More Active 2009-03-26 2026-04-30

Filings

Number Name File Date
202450246830 Annual Report 2024-04-05
202331380170 Annual Report 2023-03-22
202220602060 Annual Report 2022-06-28
202219493220 Revocation Notice For Failure to File An Annual Report 2022-06-22
202102785650 Annual Report 2021-10-06

Uniform Commercial Code

The Uniform Commercial Code (UCC) is a comprehensive set of laws governing all commercial transactions in the United States.

A UCC filing is a public notice of a secured transaction. A financing statement indicates a commercial agreement between a debtor and a secured party.

Uniform Commercial Code Summary

Type:
UCC-1 Standard
UCC Filing Number:
Filing Date:
2022-08-31
Action:
Assignment

Parties

Party Name:
642 METACOM AVENUE OPERATIONS LLC
Party Role:
Debtor(s)
Party Name:
INTEGRATED VEHICLE LEASING, INC.
Party Role:
Secured Parties

Inspections

Inspection Type Performed By Inspection Date Inspection Purpose
Food Establishment Inspection Rhode Island Department of Health, Center for Food Protection 2025-01-23 Routine
Food Establishment Inspection Rhode Island Department of Health, Center for Food Protection 2024-01-29 Routine
Food Establishment Inspection Rhode Island Department of Health, Center for Food Protection 2023-08-03 Re-Inspection
Food Establishment Inspection Rhode Island Department of Health, Center for Food Protection 2023-07-26 Routine
Food Establishment Inspection Rhode Island Department of Health, Center for Food Protection 2022-05-12 Routine

Expenditures

Agency Date Program Subprogram Amount
Department of Administration 2024-09-20 CENTRAL MANAGEMENT DIRECTOR'S OFFICE 54471.0
Department of Administration 2023-01-06 CENTRAL MANAGEMENT DIRECTOR'S OFFICE 179333.01

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Date of last update: 29 May 2025

Sources: Rhode Island Department of State