Lake Wales Health Care Operations Company LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 1951593672 Enrollment ID O20101012001399

Linked facilitiesFacilities

StatesStates

6 parties: 1 organizations · 5 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Cory Blackwell	3678944063	Individual	Operational/Managerial Control; ADP of the SNF	—
Tender Loving Care Management Inc	9931198355	Organization	Operational/Managerial Control; ADP of the SNF	—
Gary L Ott	5193635662	Individual	5% or Greater Direct Ownership Interest; Corporate Officer; ADP of the SNF	50
Dwight A Ott	8820908395	Individual	5% or Greater Direct Ownership Interest; Corporate Officer; ADP of the SNF	23
Steven Lanham	9830105626	Individual	5% or Greater Direct Ownership Interest; ADP of the SNF	10
Cullen S Gibson	3577461797	Individual	5% or Greater Direct Ownership Interest; Corporate Officer; ADP of the SNF	8

Cory BlackwellPAC 3678944063
IndividualOperational/Managerial Control; ADP of the SNF
Tender Loving Care Management IncPAC 9931198355
OrganizationOperational/Managerial Control; ADP of the SNF
Gary L OttPAC 5193635662
Individual505% or Greater Direct Ownership Interest; Corporate Officer
Dwight A OttPAC 8820908395
Individual235% or Greater Direct Ownership Interest; Corporate Officer
Steven LanhamPAC 9830105626
Individual105% or Greater Direct Ownership Interest; ADP of the SNF
Cullen S GibsonPAC 3577461797
Individual85% or Greater Direct Ownership Interest; Corporate Officer

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Astoria Health and Rehabilitation Center Lake Wales Health Care Operations Company LLC 126 residents		Other disclo…	4.20	Ovr★★★☆☆Stf★★★★☆Ins★★☆☆☆QM★★★★★	126

Astoria Health and Rehabilitation Center
Lake Wales Health Care Operations Company LLC
Other disclosed role126 res4.20 HPRD
Overall 3Staffing Staff 4

Related CMS associates

Name match to Lake Wales Health Care Operations Company LLC in FEC filings. Similar names may appear—confirm on FEC.gov.