King Street Home Inc

Enrollment entity

Provider / enrollment organization Enrollment PAC 5193888261 Enrollment ID O20090320000151

Linked facilitiesFacilities

StatesStates

4 parties: 0 organizations · 4 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Joan S Logan	8022254101	Individual	5% or Greater Direct Ownership Interest; Corporate Officer; Operational/Managerial Control	50
Robert Wilner	5092866624	Individual	5% or Greater Direct Ownership Interest; Corporate Officer; Operational/Managerial Control	50
Jennifer Borzykowski	4587180476	Individual	Operational/Managerial Control; ADP of the SNF	—
Albert L Riddle	7113819962	Individual	Operational/Managerial Control; ADP of the SNF	—

Joan S LoganPAC 8022254101
Individual505% or Greater Direct Ownership Interest; Corporate Officer
Robert WilnerPAC 5092866624
Individual505% or Greater Direct Ownership Interest; Corporate Officer
Jennifer BorzykowskiPAC 4587180476
IndividualOperational/Managerial Control; ADP of the SNF
Albert L RiddlePAC 7113819962
IndividualOperational/Managerial Control; ADP of the SNF

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
King Street Home Inc 65 residents		Other disclo…	5.06	Ovr★★☆☆☆Stf★★★★☆Ins★★☆☆☆QM★★★★☆	65

King Street Home Inc
Other disclosed role65 res5.06 HPRD
Overall 2Staffing Staff 4

Related CMS associates

Name match to King Street Home Inc in FEC filings. Similar names may appear—confirm on FEC.gov.