Blue Heron Health and Rehabilitation LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 6800201906 Enrollment ID O20210224000148

Linked facilitiesFacilities

StatesStates

5 parties: 2 organizations · 3 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Tender Loving Care Management Inc	9931198355	Organization	Operational/Managerial Control	100
Kimberly A Smith	9133039696	Individual	Corporate Director; W-2 Managing Employee	100
Gary L Ott	5193635662	Individual	5% or Greater Direct Ownership Interest; Corporate Officer	52
Ott Family Trust	3577978733	Organization	5% or Greater Direct Ownership Interest	15
Dwight A Ott	8820908395	Individual	5% or Greater Direct Ownership Interest; Corporate Officer	10

Tender Loving Care Management IncPAC 9931198355
Organization100Operational/Managerial Control
Kimberly A SmithPAC 9133039696
Individual100Corporate Director; W-2 Managing Employee
Gary L OttPAC 5193635662
Individual525% or Greater Direct Ownership Interest; Corporate Officer
Ott Family TrustPAC 3577978733
Organization155% or Greater Direct Ownership Interest
Dwight A OttPAC 8820908395
Individual105% or Greater Direct Ownership Interest; Corporate Officer

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Blue Heron Health and Rehabilitation Blue Heron Health and Rehabilitation LLC 133 residents		Other disclo…	4.02	Ovr★★★★☆Stf★★★★☆Ins★★★☆☆QM★★★★★	133

Blue Heron Health and Rehabilitation
Blue Heron Health and Rehabilitation LLC
Other disclosed role133 res4.02 HPRD
Overall 4Staffing Staff 4

Related CMS associates

Name match to Blue Heron Health and Rehabilitation LLC in FEC filings. Similar names may appear—confirm on FEC.gov.