| Name: | PROSPECT CHARTERCARE ELMHURST, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 21 Aug 2013 (12 years ago) |
| Date of Dissolution: | 22 Jul 2019 (6 years ago) |
| Date of Status Change: | 22 Jul 2019 (6 years ago) |
| Identification Number: | 000823573 |
| Principal Address: | 3415 SOUTH SEPULVEDA BOULEVARD 9TH FLOOR, LOS ANGELES, CA, 90034, USA |
| Purpose: | HEALTH CARE |
| Fictitious names: |
Elmhurst Extended Care Facility (trading name, 2014-03-25 - ) |
NAICS
621999 All Other Miscellaneous Ambulatory Health Care ServicesThis U.S. industry comprises establishments primarily engaged in providing ambulatory health care services (except offices of physicians, dentists, and other health practitioners; outpatient care centers; medical and diagnostic laboratories; home health care providers; ambulances; and blood and organ banks). Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457776452 | 2014-02-27 | 2021-01-15 | 50 MAUDE ST, PROVIDENCE, RI, 029084325, US | 50 MAUDE ST, PROVIDENCE, RI, 029084325, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 401-456-2623 |
| Fax | 4014566862 |
Authorized person
| Name | ROBERT JON ELDERS |
| Role | SECRETARY |
| Phone | 7147881249 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | LTC00663 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4105084 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 450 VETERANS MEMORIAL PARKWAY SUITE 7A, EAST PROVIDENCE, RI, 02914, USA |
| Number | Name | File Date |
|---|---|---|
| 201906378150 | Revocation Certificate For Failure to File the Annual Report for the Year | 2019-07-22 |
| 201992571350 | Revocation Notice For Failure to File An Annual Report | 2019-05-13 |
| 201752674000 | Annual Report | 2017-11-01 |
| 201628547650 | Annual Report - Amended | 2016-12-05 |
| 201609403410 | Annual Report | 2016-09-26 |
| 201580213330 | Annual Report | 2015-09-22 |
| 201449442040 | Annual Report | 2014-11-05 |
| 201437687040 | Fictitious Business Name Statement | 2014-03-25 |
| 201327041620 | Articles of Organization | 2013-08-21 |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 300096989 | 0112300 | 1998-05-11 | 50 MAUDE STREET, PROVIDENCE, RI, 02908 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 300097011 | 0112300 | 1998-05-11 | 50 MAUDE STREET, PROVIDENCE, RI, 02908 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Citation ID | 01001 |
| Citaton Type | Serious |
| Standard Cited | 19100101 B |
| Issuance Date | 1998-05-21 |
| Abatement Due Date | 1998-06-17 |
| Current Penalty | 812.5 |
| Initial Penalty | 1625.0 |
| Nr Instances | 6 |
| Nr Exposed | 2 |
| Gravity | 03 |
| Citation ID | 01002A |
| Citaton Type | Serious |
| Standard Cited | 19100147 C04 I |
| Issuance Date | 1998-05-21 |
| Abatement Due Date | 1998-08-20 |
| Current Penalty | 812.5 |
| Initial Penalty | 1625.0 |
| Nr Instances | 1 |
| Nr Exposed | 1 |
| Gravity | 03 |
| Citation ID | 01002B |
| Citaton Type | Serious |
| Standard Cited | 19100147 C07 I |
| Issuance Date | 1998-05-21 |
| Abatement Due Date | 1998-07-09 |
| Nr Instances | 2 |
| Nr Exposed | 2 |
| Gravity | 03 |
| Citation ID | 01003A |
| Citaton Type | Serious |
| Standard Cited | 19100303 B01 |
| Issuance Date | 1998-05-21 |
| Abatement Due Date | 1998-06-17 |
| Current Penalty | 812.5 |
| Initial Penalty | 1625.0 |
| Nr Instances | 2 |
| Nr Exposed | 1 |
| Gravity | 03 |
| Citation ID | 01003B |
| Citaton Type | Serious |
| Standard Cited | 19100305 B01 |
| Issuance Date | 1998-05-21 |
| Abatement Due Date | 1998-06-17 |
| Nr Instances | 2 |
| Nr Exposed | 1 |
| Gravity | 03 |
| Citation ID | 01003C |
| Citaton Type | Serious |
| Standard Cited | 19100305 B02 |
| Issuance Date | 1998-05-21 |
| Abatement Due Date | 1998-06-17 |
| Nr Instances | 1 |
| Nr Exposed | 1 |
| Gravity | 03 |
| Citation ID | 01003D |
| Citaton Type | Serious |
| Standard Cited | 19100305 G01 I |
| Issuance Date | 1998-05-21 |
| Abatement Due Date | 1998-06-17 |
| Nr Instances | 1 |
| Nr Exposed | 1 |
| Gravity | 03 |
| Citation ID | 01004 |
| Citaton Type | Serious |
| Standard Cited | 19100305 J02 II |
| Issuance Date | 1998-05-21 |
| Abatement Due Date | 1998-10-02 |
| Current Penalty | 812.5 |
| Initial Penalty | 1625.0 |
| Nr Instances | 18 |
| Nr Exposed | 7 |
| Gravity | 03 |
| Citation ID | 02001 |
| Citaton Type | Other |
| Standard Cited | 19100036 D02 |
| Issuance Date | 1998-06-04 |
| Abatement Due Date | 1998-06-30 |
| Nr Instances | 1 |
| Nr Exposed | 3 |
| Gravity | 01 |
| Citation ID | 02002 |
| Citaton Type | Other |
| Standard Cited | 19100157 C01 |
| Issuance Date | 1998-05-21 |
| Abatement Due Date | 1998-06-17 |
| Nr Instances | 1 |
| Gravity | 01 |
| Citation ID | 02003 |
| Citaton Type | Other |
| Standard Cited | 19100215 A04 |
| Issuance Date | 1998-05-21 |
| Abatement Due Date | 1998-06-17 |
| Nr Instances | 1 |
| Nr Exposed | 1 |
| Gravity | 01 |
| Citation ID | 02004 |
| Citaton Type | Other |
| Standard Cited | 19100215 B09 |
| Issuance Date | 1998-05-21 |
| Abatement Due Date | 1998-06-17 |
| Nr Instances | 1 |
| Nr Exposed | 1 |
| Gravity | 01 |
| Citation ID | 02005 |
| Citaton Type | Other |
| Standard Cited | 19100303 F |
| Issuance Date | 1998-05-21 |
| Abatement Due Date | 1998-08-20 |
| Nr Instances | 3 |
| Nr Exposed | 1 |
| Gravity | 01 |
| Citation ID | 02006 |
| Citaton Type | Other |
| Standard Cited | 19100303 G01 II |
| Issuance Date | 1998-05-21 |
| Abatement Due Date | 1998-06-17 |
| Nr Instances | 4 |
| Nr Exposed | 4 |
| Gravity | 01 |
Date of last update: 17 Oct 2024
Sources: Rhode Island Department of State
