Public record

CMS Skilled Nursing Facility All Owners

Associate id: 1658632229 · 35 matching records

Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
0244290088
Type - owner
I
Role code - owner
35
Role text - owner
5% OR GREATER INDIRECT OWNERSHIP INTEREST
Association date - owner
2017-07-20
First name - owner
LOIS
Middle name - owner
A
Last name - owner
MASTROCOLA
Title - owner
CFO
Percentage ownership
9.18
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
0244290088
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2017-07-20
First name - owner
LOIS
Middle name - owner
A
Last name - owner
MASTROCOLA
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
0244290088
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2017-07-20
First name - owner
LOIS
Middle name - owner
A
Last name - owner
MASTROCOLA
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
0244290088
Type - owner
I
Role code - owner
86
Role text - owner
INDIRECT OWNERSHIP INTEREST
Association date - owner
2017-07-20
First name - owner
LOIS
Middle name - owner
A
Last name - owner
MASTROCOLA
Percentage ownership
9.18
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
1759869829
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2025-03-17
First name - owner
ANGELO CLYDE
Last name - owner
ARGUEL
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
1759869829
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-03-17
First name - owner
ANGELO CLYDE
Last name - owner
ARGUEL
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
2567372584
Type - owner
I
Role code - owner
35
Role text - owner
5% OR GREATER INDIRECT OWNERSHIP INTEREST
Association date - owner
2017-07-20
First name - owner
THOMAS
Last name - owner
OLDS
Title - owner
CEO
Percentage ownership
78.13
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
2567372584
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2017-07-20
First name - owner
THOMAS
Last name - owner
OLDS
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
2567372584
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2017-07-20
First name - owner
THOMAS
Last name - owner
OLDS
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
2567372584
Type - owner
I
Role code - owner
86
Role text - owner
INDIRECT OWNERSHIP INTEREST
Association date - owner
2017-07-20
First name - owner
THOMAS
Last name - owner
OLDS
Percentage ownership
78.13
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
2668950734
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2016-05-13
First name - owner
KELSEY
Last name - owner
COLEMAN
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
2668950734
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2016-05-13
First name - owner
KELSEY
Last name - owner
COLEMAN
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
3173668746
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2024-01-08
First name - owner
KABIR
Last name - owner
NAIN
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
3173668746
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2024-01-08
First name - owner
KABIR
Last name - owner
NAIN
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
3577041649
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2023-10-31
First name - owner
JESUS
Last name - owner
GUTIERREZ
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
3577041649
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2023-10-31
First name - owner
JESUS
Last name - owner
GUTIERREZ
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
4486132552
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2023-07-11
First name - owner
ALBERTA
Last name - owner
AMILCAR
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
4486132552
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2023-07-11
First name - owner
ALBERTA
Last name - owner
AMILCAR
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
5193635118
Type - owner
I
Role code - owner
35
Role text - owner
5% OR GREATER INDIRECT OWNERSHIP INTEREST
Association date - owner
2017-07-20
First name - owner
FRED
Last name - owner
SMITH
Percentage ownership
12.69
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
5193635118
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2017-07-20
First name - owner
FRED
Last name - owner
SMITH
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
5193635118
Type - owner
I
Role code - owner
86
Role text - owner
INDIRECT OWNERSHIP INTEREST
Association date - owner
2017-07-20
First name - owner
FRED
Last name - owner
SMITH
Percentage ownership
12.69
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
5395223465
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2003-06-30
First name - owner
MEGAN
Last name - owner
DALY
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
5395223465
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2003-06-30
First name - owner
MEGAN
Last name - owner
DALY
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
6204314370
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2020-01-21
First name - owner
DINA
Last name - owner
DEGUZMAN
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
6204314370
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2020-01-21
First name - owner
DINA
Last name - owner
DEGUZMAN
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
7719105980
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2017-07-20
First name - owner
MICHAEL
Middle name - owner
ANTHONY
Last name - owner
NIAKI
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
7719105980
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2017-07-20
First name - owner
MICHAEL
Middle name - owner
ANTHONY
Last name - owner
NIAKI
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
7810475803
Type - owner
O
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2026-01-30
Organization name - owner
SAN RAFAEL RE, LLC
Address line 1 - owner
6 HUTTON CENTRE DR
City - owner
SANTA ANA
State - owner
CA
Zip code - owner
927075745
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
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
7810488145
Type - owner
O
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2017-07-20
Organization name - owner
THERAGEN, LLC
Address line 1 - owner
6 HUTTON CENTRE DR
Address line 2 - owner
STE 400
City - owner
SANTA ANA
State - owner
CA
Zip code - owner
927078762
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
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
7810488145
Type - owner
O
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2017-07-20
Organization name - owner
THERAGEN, LLC
Address line 1 - owner
6 HUTTON CENTRE DR
Address line 2 - owner
STE 400
City - owner
SANTA ANA
State - owner
CA
Zip code - owner
927078762
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
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
8921918947
Type - owner
O
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2017-07-20
Organization name - owner
LIFE GENERATIONS HEALTHCARE, LLC
Address line 1 - owner
6 HUTTON CENTRE DR
Address line 2 - owner
STE 400
City - owner
SANTA ANA
State - owner
CA
Zip code - owner
927078762
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
Y
Trust or trustee - owner
N
Other type - owner
N
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
8921918947
Type - owner
O
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2017-07-20
Organization name - owner
LIFE GENERATIONS HEALTHCARE, LLC
Address line 1 - owner
6 HUTTON CENTRE DR
Address line 2 - owner
STE 400
City - owner
SANTA ANA
State - owner
CA
Zip code - owner
927078762
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
Y
Trust or trustee - owner
N
Other type - owner
N
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
9234306887
Type - owner
O
Role code - owner
37
Role text - owner
5% OR GREATER SECURITY INTEREST
Association date - owner
2021-10-06
Organization name - owner
BMO BANK, N.A.
Address line 1 - owner
320 S CANAL ST
City - owner
CHICAGO
State - owner
IL
Zip code - owner
606065707
Created for acquisition - owner
N
Corporation - owner
N
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
Y
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
N
Owned by another org or ind - owner
Y
Enrollment id
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
9234306887
Type - owner
O
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2021-10-06
Organization name - owner
BMO BANK, N.A.
Address line 1 - owner
320 S CANAL ST
City - owner
CHICAGO
State - owner
IL
Zip code - owner
606065707
Corporation - owner
N
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
Y
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
O20180221002750
Associate id
1658632229
Organization name
GHC OF SAN RAFAEL, LLC
Associate id - owner
9234306887
Type - owner
O
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2021-10-06
Organization name - owner
BMO BANK, N.A.
Address line 1 - owner
320 S CANAL ST
City - owner
CHICAGO
State - owner
IL
Zip code - owner
606065707
Corporation - owner
N
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
Y
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

This record is displayed as returned by the government data source. Open the raw file · About this dataset · Full source list