Public record

CMS Skilled Nursing Facility All Owners

Associate id: 0749218584 · 13 matching records

Enrollment id
O20050802000619
Associate id
0749218584
Organization name
COUNTRYSIDE HEALTH SERVICES LLC
Associate id - owner
0749218584
Type - owner
O
Role code - owner
34
Role text - owner
5% OR GREATER DIRECT OWNERSHIP INTEREST
Association date - owner
1998-07-01
Organization name - owner
COUNTRYSIDE HEALTH SERVICES LLC
Doing business as name - owner
COUNTRYSIDE ESTATES
Address line 1 - owner
750 E HIGHWAY 64
City - owner
WARNER
State - owner
OK
Zip code - owner
744693801
Percentage ownership
100
Created for acquisition - owner
N
Corporation - owner
N
Llc - owner
Y
Medical provider supplier - owner
N
Management services company - owner
N
Medical staffing company - owner
N
Holding company - owner
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
N
Private equity company - owner
N
Reit - owner
N
Chain home office - owner
N
Trust or trustee - owner
N
Other type - owner
N
Parent company - owner
Y
Owned by another org or ind - owner
N
Enrollment id
O20050802000619
Associate id
0749218584
Organization name
COUNTRYSIDE HEALTH SERVICES LLC
Associate id - owner
0749218584
Type - owner
O
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-09-15
Organization name - owner
COUNTRYSIDE HEALTH SERVICES LLC
Doing business as name - owner
COUNTRYSIDE ESTATES
Address line 1 - owner
750 E HIGHWAY 64
City - owner
WARNER
State - owner
OK
Zip code - owner
744693801
Corporation - owner
N
Llc - owner
Y
Medical provider supplier - owner
N
Management services company - owner
N
Medical staffing company - owner
N
Holding company - owner
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
N
Private equity company - owner
N
Reit - owner
N
Chain home office - owner
N
Trust or trustee - owner
N
Other type - owner
N
Enrollment id
O20050802000619
Associate id
0749218584
Organization name
COUNTRYSIDE HEALTH SERVICES LLC
Associate id - owner
2062907454
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-06-15
First name - owner
JACE
Middle name - owner
CLARK
Last name - owner
ROGERS
Enrollment id
O20050802000619
Associate id
0749218584
Organization name
COUNTRYSIDE HEALTH SERVICES LLC
Associate id - owner
5395776553
Type - owner
I
Role code - owner
34
Role text - owner
5% OR GREATER DIRECT OWNERSHIP INTEREST
Association date - owner
2024-09-01
First name - owner
JUSTIN
Middle name - owner
TODD
Last name - owner
ROGERS
Title - owner
SECRETARY
Percentage ownership
50
Enrollment id
O20050802000619
Associate id
0749218584
Organization name
COUNTRYSIDE HEALTH SERVICES LLC
Associate id - owner
5395776553
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2000-11-27
First name - owner
JUSTIN
Middle name - owner
TODD
Last name - owner
ROGERS
Title - owner
VICE PRESIDENT
Percentage ownership
25
Enrollment id
O20050802000619
Associate id
0749218584
Organization name
COUNTRYSIDE HEALTH SERVICES LLC
Associate id - owner
5395776553
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2024-09-01
First name - owner
JUSTIN
Middle name - owner
TODD
Last name - owner
ROGERS
Enrollment id
O20050802000619
Associate id
0749218584
Organization name
COUNTRYSIDE HEALTH SERVICES LLC
Associate id - owner
7517998776
Type - owner
O
Role code - owner
34
Role text - owner
5% OR GREATER DIRECT OWNERSHIP INTEREST
Association date - owner
2013-07-18
Organization name - owner
COUNTRYSIDE ESTATES INC
Doing business as name - owner
COUNTRYSIDE ESTATES
Address line 1 - owner
P.O. BOX 749
City - owner
WARNER
State - owner
OK
Zip code - owner
744690749
Percentage ownership
100
Created for acquisition - owner
Y
Corporation - owner
Y
Llc - owner
N
Medical provider supplier - owner
N
Management services company - owner
N
Medical staffing company - owner
N
Holding company - owner
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
N
Private equity company - owner
N
Reit - owner
N
Chain home office - owner
N
Trust or trustee - owner
N
Other type - owner
N
Parent company - owner
Y
Owned by another org or ind - owner
N
Enrollment id
O20050802000619
Associate id
0749218584
Organization name
COUNTRYSIDE HEALTH SERVICES LLC
Associate id - owner
7517998776
Type - owner
O
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-09-15
Organization name - owner
COUNTRYSIDE ESTATES INC
Doing business as name - owner
COUNTRYSIDE ESTATES
Address line 1 - owner
P.O. BOX 749
City - owner
WARNER
State - owner
OK
Zip code - owner
744690749
Corporation - owner
Y
Llc - owner
N
Medical provider supplier - owner
N
Management services company - owner
N
Medical staffing company - owner
N
Holding company - owner
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
N
Private equity company - owner
N
Reit - owner
N
Chain home office - owner
N
Trust or trustee - owner
N
Other type - owner
N
Enrollment id
O20050802000619
Associate id
0749218584
Organization name
COUNTRYSIDE HEALTH SERVICES LLC
Associate id - owner
8022049287
Type - owner
I
Role code - owner
34
Role text - owner
5% OR GREATER DIRECT OWNERSHIP INTEREST
Association date - owner
2024-09-01
First name - owner
JOHN
Middle name - owner
E
Last name - owner
ROGERS
Title - owner
PRESIDENT
Percentage ownership
50
Enrollment id
O20050802000619
Associate id
0749218584
Organization name
COUNTRYSIDE HEALTH SERVICES LLC
Associate id - owner
8022049287
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2024-09-01
First name - owner
JOHN
Middle name - owner
E
Last name - owner
ROGERS
Title - owner
PRESIDENT
Percentage ownership
50
Enrollment id
O20050802000619
Associate id
0749218584
Organization name
COUNTRYSIDE HEALTH SERVICES LLC
Associate id - owner
8022049287
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2024-09-01
First name - owner
JOHN
Middle name - owner
E
Last name - owner
ROGERS
Enrollment id
O20050802000619
Associate id
0749218584
Organization name
COUNTRYSIDE HEALTH SERVICES LLC
Associate id - owner
8022049287
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2024-09-01
First name - owner
JOHN
Middle name - owner
E
Last name - owner
ROGERS
Enrollment id
O20050802000619
Associate id
0749218584
Organization name
COUNTRYSIDE HEALTH SERVICES LLC
Associate id - owner
9537585989
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-12-03
First name - owner
RYAN
Last name - owner
REYNOLDS

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