Public record

CMS Skilled Nursing Facility All Owners

Associate id: 3779892260 · 12 matching records

Enrollment id
O20151023000912
Associate id
3779892260
Organization name
CUCUMBER HOLDINGS LLC
Associate id - owner
0345438008
Type - owner
I
Role code - owner
25
Role text - owner
CONTRACTED MANAGING EMPLOYEE
Association date - owner
2023-06-01
First name - owner
KEINO
Middle name - owner
A
Last name - owner
RUTHERFORD
Title - owner
MD;
Enrollment id
O20151023000912
Associate id
3779892260
Organization name
CUCUMBER HOLDINGS LLC
Associate id - owner
0648228304
Type - owner
I
Role code - owner
35
Role text - owner
5% OR GREATER INDIRECT OWNERSHIP INTEREST
Association date - owner
2024-04-15
First name - owner
JASON
Middle name - owner
H
Last name - owner
MURRAY
Percentage ownership
41.8
Enrollment id
O20151023000912
Associate id
3779892260
Organization name
CUCUMBER HOLDINGS LLC
Associate id - owner
0648429498
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2024-01-01
First name - owner
JOHN
Middle name - owner
T
Last name - owner
MITCHELL
Title - owner
SECRETARY
Enrollment id
O20151023000912
Associate id
3779892260
Organization name
CUCUMBER HOLDINGS LLC
Associate id - owner
4486043916
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2024-01-01
First name - owner
FREDERICK
Middle name - owner
G
Last name - owner
APT
Title - owner
TREASURER
Enrollment id
O20151023000912
Associate id
3779892260
Organization name
CUCUMBER HOLDINGS LLC
Associate id - owner
5294133575
Type - owner
I
Role code - owner
42
Role text - owner
W-2 MANAGING EMPLOYEE
Association date - owner
2021-10-01
First name - owner
SAMUEL
Last name - owner
HARTLEY
Title - owner
ADMINISTRATOR
Enrollment id
O20151023000912
Associate id
3779892260
Organization name
CUCUMBER HOLDINGS LLC
Associate id - owner
5294133575
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2021-10-01
First name - owner
SAMUEL
Last name - owner
HARTLEY
Title - owner
ADMINISTRATOR
Enrollment id
O20151023000912
Associate id
3779892260
Organization name
CUCUMBER HOLDINGS LLC
Associate id - owner
5294198396
Type - owner
O
Role code - owner
34
Role text - owner
5% OR GREATER DIRECT OWNERSHIP INTEREST
Association date - owner
2023-06-30
Organization name - owner
PROVIDENCE GROUP NH, LLC
Address line 1 - owner
262 N UNIVERSITY AVE
City - owner
FARMINGTON
State - owner
UT
Zip code - owner
840252975
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
Y
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
O20151023000912
Associate id
3779892260
Organization name
CUCUMBER HOLDINGS LLC
Associate id - owner
6103289202
Type - owner
O
Role code - owner
35
Role text - owner
5% OR GREATER INDIRECT OWNERSHIP INTEREST
Association date - owner
2023-06-30
Organization name - owner
PACS HOLDINGS, LLC
Address line 1 - owner
262 N UNIVERSITY AVE
City - owner
FARMINGTON
State - owner
UT
Zip code - owner
840252975
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
Y
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
O20151023000912
Associate id
3779892260
Organization name
CUCUMBER HOLDINGS LLC
Associate id - owner
6800024092
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2024-01-01
First name - owner
JOSHUA
Middle name - owner
O
Last name - owner
JERGENSEN
Title - owner
PRESIDENT
Enrollment id
O20151023000912
Associate id
3779892260
Organization name
CUCUMBER HOLDINGS LLC
Associate id - owner
7911360011
Type - owner
O
Role code - owner
35
Role text - owner
5% OR GREATER INDIRECT OWNERSHIP INTEREST
Association date - owner
2023-06-30
Organization name - owner
PACS GROUP, INC.
Address line 1 - owner
262 N UNIVERSITY AVE
City - owner
FARMINGTON
State - owner
UT
Zip code - owner
840252975
Percentage ownership
100
Created for acquisition - owner
N
Corporation - owner
Y
Llc - owner
N
Medical provider supplier - owner
N
Management services company - owner
N
Medical staffing company - owner
N
Holding company - owner
Y
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
Y
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
O20151023000912
Associate id
3779892260
Organization name
CUCUMBER HOLDINGS LLC
Associate id - owner
9830337005
Type - owner
I
Role code - owner
35
Role text - owner
5% OR GREATER INDIRECT OWNERSHIP INTEREST
Association date - owner
2024-04-15
First name - owner
MARK
Middle name - owner
D
Last name - owner
HANCOCK
Percentage ownership
41.8
Enrollment id
O20151023000912
Associate id
3779892260
Organization name
CUCUMBER HOLDINGS LLC
Associate id - owner
9830337005
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2024-01-01
First name - owner
MARK
Middle name - owner
D
Last name - owner
HANCOCK
Title - owner
CEO

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