Public record

CMS Skilled Nursing Facility All Owners

Associate id: 5698819746 · 40 matching records

Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
0547776718
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2015-10-26
First name - owner
JACOB
Last name - owner
BOWER
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
0547776718
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2015-10-26
First name - owner
JACOB
Last name - owner
BOWER
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
0648786814
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2024-04-16
First name - owner
SCOTT
Last name - owner
BARNES
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
0648786814
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2024-04-16
First name - owner
SCOTT
Last name - owner
BARNES
Title - owner
BOARD MEMBER
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
0749796910
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2024-06-18
First name - owner
RONNIE
Last name - owner
CROUCH
Title - owner
PRESIDENT
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
0749796910
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2009-07-21
First name - owner
RONNIE
Last name - owner
CROUCH
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
0749796910
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2009-07-21
First name - owner
RONNIE
Last name - owner
CROUCH
Title - owner
PRESIDENT
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
1557877727
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2024-05-21
First name - owner
PHILLIP
Last name - owner
HOOD
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
1557877727
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2024-05-21
First name - owner
PHILLIP
Last name - owner
HOOD
Title - owner
BOARD MEMBER
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
1658887823
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2017-11-21
First name - owner
PAUL
Last name - owner
WIESE
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
1658887823
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2017-11-21
First name - owner
PAUL
Last name - owner
WIESE
Title - owner
VICE PRESIDENT
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
2365958535
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2000-09-02
First name - owner
SUSAN
Last name - owner
BARTON
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
2466968631
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2024-08-20
First name - owner
JERRY
Last name - owner
RIBBING
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
2466968631
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2024-08-20
First name - owner
JERRY
Last name - owner
RIBBING
Title - owner
BOARD MEMBER
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
2567978737
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2019-12-17
First name - owner
DEBI
Last name - owner
HERNDON
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
2567978737
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2019-12-17
First name - owner
DEBI
Last name - owner
HERNDON
Title - owner
TREASURER
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
3274049440
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
1998-10-31
First name - owner
TAMMY
Last name - owner
BICKFORD
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
3274049440
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
1998-10-31
First name - owner
TAMMY
Last name - owner
BICKFORD
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
4183130354
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2025-05-20
First name - owner
KAITLIN
Last name - owner
FAUCETT
Title - owner
BOARD MEMBER
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
4284140450
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2023-05-22
First name - owner
DANIELLE
Last name - owner
PAUDA
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
4284140450
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2022-05-22
First name - owner
DANIELLE
Last name - owner
PAUDA
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
5092221267
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2025-06-17
First name - owner
CHARLES
Last name - owner
BURTON
Title - owner
BOARD MEMBER
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
5294241469
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2016-04-19
First name - owner
JOEL
Last name - owner
JUSTUS
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
5294241469
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2016-04-19
First name - owner
JOEL
Last name - owner
JUSTUS
Title - owner
SECRETARY
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
6204746860
Type - owner
O
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2005-11-01
Organization name - owner
AEGIS THERAPIES, INC.
Doing business as name - owner
AEGIS MEDICAL SUPPLY
Address line 1 - owner
4933 OLD GREENWOOD RD
City - owner
FORT SMITH
State - owner
AR
Zip code - owner
729036906
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
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
6901312172
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2025-06-17
First name - owner
HELEN
Last name - owner
GAROUTTE
Title - owner
BOARD MEMBER
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
7012423288
Type - owner
O
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
1999-10-18
Organization name - owner
DBA DIETARY CONSULTANTS OF SOUTHWEST MISSOURI
Address line 1 - owner
5210 S SHARI LN
City - owner
ROGERSVILLE
State - owner
MO
Zip code - owner
657429474
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
N
Consulting firm - owner
Y
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
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
7416866603
Type - owner
O
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2009-01-28
Organization name - owner
FORVIS MAZARS LLP
Doing business as name - owner
FORVIS MAZARS, LLP
Address line 1 - owner
910 E SAINT LOUIS ST
City - owner
SPRINGFIELD
State - owner
MO
Zip code - owner
658062580
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
Y
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
Y
Other type text - owner
ACCOUNTING
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
7810403086
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2025-03-05
First name - owner
MELISSA
Last name - owner
WEBB
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
7810403086
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2023-03-05
First name - owner
MELISSA
Last name - owner
WEBB
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
7911413182
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2012-10-16
First name - owner
TIM
Last name - owner
RICE
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
7911413182
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2012-10-16
First name - owner
TIM
Last name - owner
RICE
Title - owner
BOARD MEMBER
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
8224082482
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-04-25
First name - owner
FERNANDO
Last name - owner
CAVERO
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
8729594999
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2014-10-02
First name - owner
ASHLEY
Last name - owner
HENDRIX
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
8729594999
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2014-10-02
First name - owner
ASHLEY
Last name - owner
HENDRIX
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
8820504095
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2021-01-01
First name - owner
WADE
Last name - owner
ROGERS
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
8820504095
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2021-01-01
First name - owner
WADE
Last name - owner
ROGERS
Title - owner
BOARD MEMBER
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
9638244114
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-06-16
First name - owner
WANDA
Last name - owner
WEST
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
9739695909
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2023-05-16
First name - owner
GARY
Last name - owner
TIPPETT
Enrollment id
O20100212000691
Associate id
5698819746
Organization name
LACOBA HOMES INC
Associate id - owner
9739695909
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2023-05-16
First name - owner
GARY
Last name - owner
TIPPETT
Title - owner
BOARD MEMBER

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