Licking No 1 LLC

Enrollment entity
Provider / enrollment organization Enrollment PAC 0345507521 Enrollment ID O20171122002453

Details

Linked facilitiesFacilities
1
StatesStates
1

16 parties: 8 organizations · 8 individuals

Owners & control parties

NameOwner/control PACTypeRole(s)%
Tina Caudill6901383744IndividualOperational/Managerial Control; ADP of the SNF
Jonathan R Beers0244419851IndividualOperational/Managerial Control; ADP of the SNF
Lindi Diana Schmitt9830606102IndividualOperational/Managerial Control; ADP of the SNF
Angie Warner5496262768IndividualOperational/Managerial Control; ADP of the SNF
Todd Beaird4789079096IndividualOperational/Managerial Control; ADP of the SNF
Sovereign Healthcare Group LLC2365827185OrganizationOperational/Managerial Control; ADP of the SNF
AGH1 LLC8123547528OrganizationOperational/Managerial Control; ADP of the SNF
Donald B Bedell5092623827IndividualOperational/Managerial Control
The Licking Exempt Trust5597022715OrganizationTrustee of the SNF; Direct Ownership Interest100
Forvis Mazars LLP7416866603OrganizationADP of the SNF
Fg LLC2668991068OrganizationADP of the SNF
MID States Inc2769901164OrganizationADP of the SNF
The City of Licking9133636400OrganizationADP of the SNF
Van De Ven LLC3577082973OrganizationADP of the SNF
Unknown party0941717219IndividualADP of the SNF
Unknown party3678080942IndividualADP of the SNF

Linked facilities

Facility Location % Own. HPRD Ratings Census Flags
Hickory Manor
Licking No 1 LLC
37 residents
Other disclo…
3.70Ovr★★★☆☆Stf★★☆☆☆Ins★★★★QM☆☆☆☆37
  • Licking No 1 LLC
    Other disclosed role37 res3.70 HPRD
    Overall 3Staffing Staff 2
Related CMS associates

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Name match to Licking No 1 LLC in FEC filings. Similar names may appear—confirm on FEC.gov.