Public record

CMS Skilled Nursing Facility All Owners

Associate id: 8628105699 · 24 matching records

Enrollment id
O20100422000750
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
1153646831
Type - owner
O
Role code - owner
35
Role text - owner
5% OR GREATER INDIRECT OWNERSHIP INTEREST
Association date - owner
1982-04-28
Organization name - owner
GENESIS HEALTH INC
Address line 1 - owner
3599 UNIVERSITY BLVD S
City - owner
JACKSONVILLE
State - owner
FL
Zip code - owner
322164252
Percentage ownership
100
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
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
Y
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
O20100422000750
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
2860529831
Type - owner
O
Role code - owner
34
Role text - owner
5% OR GREATER DIRECT OWNERSHIP INTEREST
Association date - owner
2010-06-01
Organization name - owner
BROOKS SKILLED NURSING, INC.
Address line 1 - owner
3599 UNIVERSITY BLVD S
City - owner
JACKSONVILLE
State - owner
FL
Zip code - owner
322164252
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
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
N
Owned by another org or ind - owner
Y
Enrollment id
O20100422000750
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
3577590314
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2020-01-01
First name - owner
CHONGLUN
Last name - owner
XIE
Enrollment id
O20100422000750
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
3577590314
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-02-24
First name - owner
CHONGLUN
Last name - owner
XIE
Enrollment id
O20100422000750
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
3678001203
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2023-02-01
First name - owner
VICTOR
Last name - owner
DERIENZO
Enrollment id
O20100422000750
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
5193755866
Type - owner
I
Role code - owner
41
Role text - owner
CORPORATE DIRECTOR
Association date - owner
2010-06-01
First name - owner
DOUGLAS
Last name - owner
BAER
Title - owner
CEO
Enrollment id
O20100422000750
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
5698919355
Type - owner
I
Role code - owner
41
Role text - owner
CORPORATE DIRECTOR
Association date - owner
2023-02-01
First name - owner
ERIC
Last name - owner
MANN
Title - owner
DIRECTOR
Enrollment id
O20100422000750
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
5890215875
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2025-02-10
First name - owner
JENNIFER
Last name - owner
ALLEN
Enrollment id
O20100422000750
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
7810091683
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2022-02-28
First name - owner
JAMES
Last name - owner
TABOR
Title - owner
CHIEF FINANCIAL OFFICER
Enrollment id
O20100422000750
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
8820310949
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2023-02-01
First name - owner
MARC
Last name - owner
LEI
Enrollment id
O20100422000750
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
8820310949
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2023-02-01
First name - owner
MARC
Last name - owner
LEI
Enrollment id
O20160418000589
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
1153646831
Type - owner
O
Role code - owner
35
Role text - owner
5% OR GREATER INDIRECT OWNERSHIP INTEREST
Association date - owner
1982-04-28
Organization name - owner
GENESIS HEALTH INC
Address line 1 - owner
3599 UNIVERSITY BLVD S
City - owner
JACKSONVILLE
State - owner
FL
Zip code - owner
32216
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
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
Y
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
O20160418000589
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
2860529831
Type - owner
O
Role code - owner
34
Role text - owner
5% OR GREATER DIRECT OWNERSHIP INTEREST
Association date - owner
2010-03-18
Organization name - owner
BROOKS SKILLED NURSING, INC.
Address line 1 - owner
3599 UNIVERSITY BLVD S
City - owner
JACKSONVILLE
State - owner
FL
Zip code - owner
322164252
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
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
Y
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
O20160418000589
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
3577590314
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2020-01-01
First name - owner
CHONGLUN
Last name - owner
XIE
Enrollment id
O20160418000589
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
3577590314
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-03-10
First name - owner
CHONGLUN
Last name - owner
XIE
Enrollment id
O20160418000589
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
3678001203
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2021-11-19
First name - owner
VICTOR
Last name - owner
DERIENZO
Title - owner
COO
Enrollment id
O20160418000589
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
4385163054
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-01-01
Enrollment id
O20160418000589
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
5193755866
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2010-03-18
First name - owner
DOUGLAS
Last name - owner
BAER
Title - owner
VP
Enrollment id
O20160418000589
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
5496161549
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2025-02-11
First name - owner
TAYLOR
Last name - owner
BECHT
Enrollment id
O20160418000589
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
5496161549
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-03-10
First name - owner
TAYLOR
Last name - owner
BECHT
Enrollment id
O20160418000589
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
5698919355
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2023-02-01
First name - owner
ERIC
Last name - owner
MANN
Title - owner
DIRECTOR
Enrollment id
O20160418000589
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
5890215875
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2025-02-10
First name - owner
JENNIFER
Last name - owner
ALLEN
Enrollment id
O20160418000589
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
7416866603
Type - owner
O
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-01-01
Organization name - owner
FORVIS MAZARS LLP
Doing business as name - owner
FORVIS MAZARS, LLP
Address line 1 - owner
910 E SAINT LOUIS ST
Address line 2 - owner
STE 400
City - owner
SPRINGFIELD
State - owner
MO
Zip code - owner
658062570
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
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
Y
Other type text - owner
ACCOUNTING FIRM
Enrollment id
O20160418000589
Associate id
8628105699
Organization name
BROOKS SKILLED NURSING FACILITY, A, INC.
Associate id - owner
7810091683
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2022-02-28
First name - owner
JAMES
Last name - owner
TABOR
Title - owner
CHIEF FINANCIAL OFFICER

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