1130 W La Palma Ave Inc

Enrollment entity
Provider / enrollment organization Enrollment PAC 3779486071 Enrollment ID O20040202000386

Details

Linked facilitiesFacilities
1
StatesStates
1

19 parties: 7 organizations · 12 individuals

Owners & control parties

NameOwner/control PACTypeRole(s)%
Simcha Mandelbaum2466346614IndividualOperational/Managerial Control; ADP of the SNF
Gerardo Perez6204331721IndividualOperational/Managerial Control; ADP of the SNF
Kyung-my Lee7012412539IndividualOperational/Managerial Control; ADP of the SNF
Reza Talebi Dolouei6507167053IndividualOperational/Managerial Control; ADP of the SNF
Joylourdes Torres1850896374IndividualOperational/Managerial Control; ADP of the SNF
Danilo Gonzalez4486159902IndividualOperational/Managerial Control; ADP of the SNF
Maria Castro-garcia4688061286IndividualCorporate Officer; Corporate Director; Operational/Managerial Control
Mary Martillano5395240816IndividualOperational/Managerial Control; ADP of the SNF
Clinton Williams9931616521IndividualOperational/Managerial Control; ADP of the SNF
Lizette Cortez3577068097IndividualOperational/Managerial Control; ADP of the SNF
Julie Pham0648412486IndividualOperational/Managerial Control; ADP of the SNF
The Bentzion Mandelbaum 2021 Irrevocable Gift Trust No. 24789079807Organization5% or Greater Direct Ownership Interest50
Simcha and Janet Mandelbaum Family Trust6204292790Organization5% or Greater Direct Ownership Interest20
The Janet Mandelbaum 2021 Irrevocable Gift Trust No 28224423348Organization5% or Greater Direct Ownership Interest16
The Simcha Mandelbaum 2021 Irrevocable Gift Trust No. 27012373509Organization5% or Greater Direct Ownership Interest14
Janet Mandelbaum0941341648IndividualCorporate Officer; Corporate Director50
Hansen1951789437OrganizationADP of the SNF
Skillserve Inc4587939145OrganizationADP of the SNF
Unknown party2860997384OrganizationADP of the SNF

Linked facilities

Facility Location Role / stake HPRD Ratings Census Flags
La Palma Nursing Center
1130 W La Palma Ave Inc
62 residents
Other disclo…
5.68Ovr★★★★★Stf★★★★★Ins★★★☆☆QM★★★★★62
  • 1130 W La Palma Ave Inc
    Other disclosed role62 res5.68 HPRD
    Overall 5Staffing Staff 5
Related CMS associates

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Name match to 1130 W La Palma Ave Inc in FEC filings. Similar names may appear—confirm on FEC.gov.