Public record

CMS Skilled Nursing Facility All Owners

Associate id: 6507347515 · 11 matching records

Enrollment id
O20260226002845
Associate id
6507347515
Organization name
5377 JAX OPCO LLC
Associate id - owner
3779065933
Type - owner
O
Role code - owner
34
Role text - owner
5% OR GREATER DIRECT OWNERSHIP INTEREST
Association date - owner
2023-05-01
Organization name - owner
5377 JAX OPCO HOLDCO LLC
Address line 1 - owner
31 BROOKFALL RD
City - owner
EDISON
State - owner
NJ
Zip code - owner
08817
Percentage ownership
100
Created for acquisition - owner
Y
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
Parent company - owner
N
Owned by another org or ind - owner
Y
Enrollment id
O20260226002845
Associate id
6507347515
Organization name
5377 JAX OPCO LLC
Associate id - owner
5698072395
Type - owner
I
Role code - owner
35
Role text - owner
5% OR GREATER INDIRECT OWNERSHIP INTEREST
Association date - owner
2023-05-01
First name - owner
ELIYAHU
Last name - owner
MIRLIS
Percentage ownership
100
Enrollment id
O20260226002845
Associate id
6507347515
Organization name
5377 JAX OPCO LLC
Associate id - owner
5698072395
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2025-05-01
First name - owner
ELIYAHU
Last name - owner
MIRLIS
Enrollment id
O20260226002845
Associate id
6507347515
Organization name
5377 JAX OPCO LLC
Associate id - owner
5698072395
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-05-01
First name - owner
ELIYAHU
Last name - owner
MIRLIS
Enrollment id
O20260226002845
Associate id
6507347515
Organization name
5377 JAX OPCO LLC
Associate id - owner
7012347974
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2025-10-31
First name - owner
KEVIN
Last name - owner
BRYANT
Enrollment id
O20260226002845
Associate id
6507347515
Organization name
5377 JAX OPCO LLC
Associate id - owner
7012347974
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2025-10-31
First name - owner
KEVIN
Last name - owner
BRYANT
Title - owner
ADMINISTRATOR
Enrollment id
O20260226002845
Associate id
6507347515
Organization name
5377 JAX OPCO LLC
Associate id - owner
7012347974
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-10-31
First name - owner
KEVIN
Last name - owner
BRYANT
Enrollment id
O20260226002845
Associate id
6507347515
Organization name
5377 JAX OPCO LLC
Associate id - owner
7517448400
Type - owner
O
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-05-01
Organization name - owner
5377 MONCRIEF REALTY LLC
Address line 1 - owner
31 BROOKFALL RD
City - owner
EDISON
State - owner
NJ
Zip code - owner
08817
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
O20260226002845
Associate id
6507347515
Organization name
5377 JAX OPCO LLC
Associate id - owner
8123054939
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2025-05-01
First name - owner
PHUC
Middle name - owner
V
Last name - owner
TRAN
Enrollment id
O20260226002845
Associate id
6507347515
Organization name
5377 JAX OPCO LLC
Associate id - owner
8123054939
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2025-05-01
First name - owner
PHUC
Middle name - owner
V
Last name - owner
TRAN
Title - owner
MEDICAL DIRECTOR
Enrollment id
O20260226002845
Associate id
6507347515
Organization name
5377 JAX OPCO LLC
Associate id - owner
8123054939
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-05-01
First name - owner
PHUC
Middle name - owner
V
Last name - owner
TRAN

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