Providence Park Inc

Enrollment entity
Provider / enrollment organization Enrollment PAC 0749597045 Enrollment ID O20150918002016

Details

Linked facilitiesFacilities
1
StatesStates
1

9 parties: 3 organizations · 6 individuals

Owners & control parties

NameOwner/control PACTypeRole(s)%
Amy K Lefco2961585120IndividualOperational/Managerial Control; ADP of the SNF
Darrell R Pietsch2365330701IndividualOperational/Managerial Control; ADP of the SNF
Ascension Health Senior Care4284850090Organization5% or Greater Direct Ownership Interest; ADP of the SNF100
Erin Shadbolt9335419134IndividualCorporate Officer; ADP of the SNF
Kenneth Smoot8729151006IndividualCorporate Director; ADP of the SNF
Lisa Musgrave7618148487IndividualCorporate Director; ADP of the SNF
Ryan Breedlove6507205713IndividualCorporate Director; ADP of the SNF
Health Dimensions Consulting Inc1759379878OrganizationADP of the SNF
Medical Solutions LLC1658879465OrganizationADP of the SNF

Linked facilities

Facility Location Role / stake HPRD Ratings Census Flags
St. Catherine Center
Providence Park Inc
144 residents
Other disclo…
3.94Ovr★★★★★Stf★★★★★Ins★★★★QM★★☆☆☆144
  • Providence Park Inc
    Other disclosed role144 res3.94 HPRD
    Overall 5Staffing Staff 5
Related CMS associates

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Name match to Providence Park Inc in FEC filings. Similar names may appear—confirm on FEC.gov.