Pacific Villa Inc

Enrollment entity

Provider / enrollment organization Enrollment PAC 8123343092 Enrollment ID O20150217001762

Linked facilitiesFacilities

StatesStates

5 parties: 0 organizations · 5 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Lina Buted	2466921408	Individual	Operational/Managerial Control; ADP of the SNF	—
Trevor Anderson	3476073826	Individual	Operational/Managerial Control; ADP of the SNF	—
Vicki P Rollins	7810807526	Individual	5% or Greater Direct Ownership Interest; 5% or Greater Indirect Ownership Interest; 5% or Greater Mortgage Interest	50
William A Nelson	4981597846	Individual	5% or Greater Direct Ownership Interest; 5% or Greater Indirect Ownership Interest; 5% or Greater Mortgage Interest	50
Ronald J Philipp	9931160041	Individual	ADP of the SNF	—

Lina ButedPAC 2466921408
IndividualOperational/Managerial Control; ADP of the SNF
Trevor AndersonPAC 3476073826
IndividualOperational/Managerial Control; ADP of the SNF
Vicki P RollinsPAC 7810807526
Individual505% or Greater Direct Ownership Interest; 5% or Greater Indirect Ownership Interest
William A NelsonPAC 4981597846
Individual505% or Greater Direct Ownership Interest; 5% or Greater Indirect Ownership Interest
Ronald J PhilippPAC 9931160041
IndividualADP of the SNF

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Pacific Villa, Inc Pacific Villa Inc 85 residents		Other disclo…	4.06	Ovr★★☆☆☆Stf★★★☆☆Ins★★☆☆☆QM★★★★☆	85

Pacific Villa, Inc
Pacific Villa Inc
Other disclosed role85 res4.06 HPRD
Overall 2Staffing Staff 3

Related CMS associates

Name match to Pacific Villa Inc in FEC filings. Similar names may appear—confirm on FEC.gov.