North Shore Manor, Inc.

Enrollment entity

Provider / enrollment organization Enrollment PAC 1456240894 Enrollment ID O20100202000910

Linked facilitiesFacilities

StatesStates

8 parties: 2 organizations · 6 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Jacqueline K King	0547624009	Individual	Operational/Managerial Control	100
Qp Health Care Services LLC	6002078037	Organization	Operational/Managerial Control	100
Columbine Management Services Inc	7315020674	Organization	Operational/Managerial Control	0
Jay H Moskowitz	3971591264	Individual	Contracted Managing Employee; Corporate Officer	100, 82
Barry Kent Fancher	6406755859	Individual	Corporate Officer; W-2 Managing Employee	100
John Robert Wilson	2062311418	Individual	5% or Greater Direct Ownership Interest; Corporate Director; W-2 Managing Employee	15, 100
Lauren J Fasciano-sager	5597904474	Individual	Corporate Officer; W-2 Managing Employee	0
Mary E Koretke	2365591294	Individual	W-2 Managing Employee	—

Jacqueline K KingPAC 0547624009
Individual100Operational/Managerial Control
Qp Health Care Services LLCPAC 6002078037
Organization100Operational/Managerial Control
Columbine Management Services IncPAC 7315020674
Organization0Operational/Managerial Control
Jay H MoskowitzPAC 3971591264
Individual100, 82Contracted Managing Employee; Corporate Officer
Barry Kent FancherPAC 6406755859
Individual100Corporate Officer; W-2 Managing Employee
John Robert WilsonPAC 2062311418
Individual15, 1005% or Greater Direct Ownership Interest; Corporate Director
Lauren J Fasciano-sagerPAC 5597904474
Individual0Corporate Officer; W-2 Managing Employee
Mary E KoretkePAC 2365591294
IndividualW-2 Managing Employee

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
North Shore Health & Rehab Facility North Shore Manor, Inc. 104 residents		Other disclo…	3.57	Ovr★★★★☆Stf★★★☆☆Ins★★★★☆QM★★★★☆	104

North Shore Health & Rehab Facility
North Shore Manor, Inc.
Other disclosed role104 res3.57 HPRD
Overall 4Staffing Staff 3

Related CMS associates

Name match to North Shore Manor, Inc. in FEC filings. Similar names may appear—confirm on FEC.gov.