Petalumaidence Opco LLC

Enrollment entity
Provider / enrollment organization Enrollment PAC 9830474774 Enrollment ID O20170316000632

Details

Linked facilitiesFacilities
1
StatesStates
1

11 parties: 4 organizations · 7 individuals

Owners & control parties

NameOwner/control PACTypeRole(s)%
Kevan Bills7214326784IndividualW-2 Managing Employee; Operational/Managerial Control
Rajina R Ranadive5698678019IndividualContracted Managing Employee
Providence Group Wine Country LLC0547545543Organization5% or Greater Direct Ownership Interest100
Pacs Group, Inc.7911360011Organization5% or Greater Indirect Ownership Interest100
Pacs Holdings, LLC6103289202Organization5% or Greater Indirect Ownership Interest100
Providence Group Nh, LLC5294198396Organization5% or Greater Indirect Ownership Interest100
Jason H Murray0648228304Individual5% or Greater Indirect Ownership Interest41.8
Mark D Hancock9830337005Individual5% or Greater Indirect Ownership Interest; Corporate Officer41.8
Frederick G Apt4486043916IndividualCorporate Officer
John T Mitchell0648429498IndividualCorporate Officer
Joshua O Jergensen6800024092IndividualCorporate Officer

Linked facilities

Facility Location Role / stake HPRD Ratings Census Flags
Vineyard Post Acute
Petalumaidence Opco LLC
96 residents
Other disclo…
3.99Ovr★★★☆☆Stf★★★☆☆Ins★★☆☆☆QM★★★★★96
  • Petalumaidence Opco LLC
    Other disclosed role96 res3.99 HPRD
    Overall 3Staffing Staff 3

Ownership history

1 CMS ownership change record (showing 1)

EffectiveFacilityBuyerSellerSide
12/16/2016Vineyard Post AcutePetalumaidence Opco LLCBeverly Health and Rehabilitiation Services, IncBuyer
  1. 12/16/2016
    Beverly Health and Rehabilitiation Services, IncPetalumaidence Opco LLC
Related CMS associates

FEC political contributions FEC contributions Beta

Name match to Petalumaidence Opco LLC in FEC filings. Similar names may appear—confirm on FEC.gov.