Public record

CMS Skilled Nursing Facility All Owners

Associate id - owner: 0749775005 · 3 matching records

Enrollment id
O20151120002749
Associate id
5395045405
Organization name
FAIRHAVEN OPCO, LLC
Associate id - owner
0749775005
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2019-05-03
First name - owner
MARY-JESSE
Last name - owner
MATHIS
Enrollment id
O20151120002749
Associate id
5395045405
Organization name
FAIRHAVEN OPCO, LLC
Associate id - owner
0749775005
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2019-05-03
First name - owner
MARY-JESSE
Last name - owner
MATHIS
Title - owner
MEMBER OF GOVERNING BODY
Enrollment id
O20151120002749
Associate id
5395045405
Organization name
FAIRHAVEN OPCO, LLC
Associate id - owner
0749775005
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2019-05-03
First name - owner
MARY-JESSE
Last name - owner
MATHIS

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