Kingdom Rehab Center, LLC

Enrollment entity
Provider / enrollment organization Enrollment PAC 9830123801 Enrollment ID O20050920000991

Details

Linked facilitiesFacilities
1
StatesStates
1

13 parties: 4 organizations · 9 individuals

Owners & control parties

NameOwner/control PACTypeRole(s)%
Patricia Russell5890729768Individual5% or Greater Direct Ownership Interest; 5% or Greater Security Interest; General Partnership Interest50
Travis B Bergeron3577087741IndividualCorporate Officer; Operational/Managerial Control; ADP of the SNF0
Maria Fatigati9436176971IndividualOperational/Managerial Control; ADP of the SNF
Francis E Cheney Jr Estate1850815028Organization5% or Greater Direct Ownership Interest; ADP of the SNF50
Warren Rice2668996836IndividualCorporate Officer; ADP of the SNF
Dale Atwood6204350473IndividualCorporate Officer; ADP of the SNF
Holly A Cummings1759805922IndividualCorporate Officer; ADP of the SNF
Unknown party1759805591OrganizationADP of the SNF
Unknown party6204350044OrganizationADP of the SNF
Unknown party7618491457IndividualADP of the SNF
Unknown party8527582360IndividualADP of the SNF
Unknown party2264956002IndividualADP of the SNF
Community National Bank4486178225Organization5% or Greater Mortgage Interest15

Linked facilities

Facility Location Role / stake HPRD Ratings Census Flags
Maple Lane Nursing Home
Kingdom Rehab Center, LLC
65 residents
Other disclo…
4.34Ovr★★★★★Stf★★★☆☆Ins★★★★★QM★★☆☆☆65
  • Kingdom Rehab Center, LLC
    Other disclosed role65 res4.34 HPRD
    Overall 5Staffing Staff 3
Related CMS associates

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Name match to Kingdom Rehab Center, LLC in FEC filings. Similar names may appear—confirm on FEC.gov.