Public record

CMS Skilled Nursing Facility All Owners

Associate id - owner: 5092724963 · 4 matching records

Enrollment id
O20130517000543
Associate id
8921917550
Organization name
SOUTHSIDE HEALTHCARE INC
Associate id - owner
5092724963
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2017-06-03
First name - owner
DOUGLAS
Middle name - owner
A
Last name - owner
WILLIAMS
Title - owner
ADMINISTRATOR
Percentage ownership
0
Enrollment id
O20130517000543
Associate id
8921917550
Organization name
SOUTHSIDE HEALTHCARE INC
Associate id - owner
5092724963
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2017-06-03
First name - owner
DOUGLAS
Middle name - owner
A
Last name - owner
WILLIAMS
Title - owner
ADMINISTRATOR
Enrollment id
O20130517000543
Associate id
8921917550
Organization name
SOUTHSIDE HEALTHCARE INC
Associate id - owner
5092724963
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-08-05
First name - owner
DOUGLAS
Middle name - owner
A
Last name - owner
WILLIAMS
Enrollment id
O20210512002476
Associate id
6406265933
Organization name
DT VALLEY LLC
Associate id - owner
5092724963
Type - owner
I
Role code - owner
42
Role text - owner
W-2 MANAGING EMPLOYEE
Association date - owner
2021-04-01
First name - owner
DOUGLAS
Middle name - owner
A
Last name - owner
WILLIAMS
Title - owner
ADMINISTRATOR

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