| Entity Name: | CLARK SKILLED NURSING FACILITY, LLC |
| Jurisdiction: | Illinois |
| Entity Type: | Limited Liability Company |
| Status: | Goodstanding |
| Date Formed: | 08 Jul 2016 |
| Company Number: | LLC_05892937 |
| File Number: | 05892937 |
| Type of Management: | Manager Managed |
| Date Status Change: | 14 Jun 2024 |
| Address | 3450 OAKTON STREET, SKOKIE, 60076, IL |
| Place of Formation: | ILLINOIS |
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JFPUF1A1JCZ4 | 2024-12-04 | 3450 OAKTON ST, SKOKIE, IL, 60076, 2951, USA | 3450 OAKTON STREET, SKOKIE, IL, 60076, USA | |||||||||||||||||||||||||||||||||||||||||
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| Congressional District | 09 |
| State/Country of Incorporation | IL, USA |
| Activation Date | 2023-12-20 |
| Initial Registration Date | 2017-10-16 |
| Entity Start Date | 2016-09-01 |
| Fiscal Year End Close Date | Dec 31 |
Service Classifications
| NAICS Codes | 623110 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | ANNA HINTZ |
| Role | AR DIRECTOR |
| Address | 3450 OAKTON STREET, SKOKIE, IL, 60076, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | JOANNE VENTRELLA |
| Role | ADMINISTRATOR |
| Address | 7433 N CLARK STREET, CHICAGO, IL, 60626, USA |
| Past Performance | Information not Available |
|---|
| Name and Address | Role | Appointment Date |
|---|---|---|
| ILLINOIS CORPORATION SERVICE COMPANY, 801 ADLAI STEVENSON DRIVE, SPRINGFIELD, 62703 | Agent | 2019-09-20 |
| Name and Address | Role | Account Number | Appointment Date |
|---|---|---|---|
| LEGACY HEALTHCARE FINANCIAL SERVICES, LLC, 3450 OAKTON ST., SKOKIE, IL, 60076 | Manager | No data | 2024-06-14 |
| Legacy Healthcare Financial Services, LLC | Manager | 411710 | No data |
| Name and Address | Role | Account Number |
|---|---|---|
| GPN Family Trust | Member | 411710 |
| Menachem & Ahuva Shabat Descendants Trust | Member | 411710 |
| Name and Address | Role | Account Number |
|---|---|---|
| Daniel S Garden | Other | 411710 |
| License Type | License Number | Status | License Code | License Description | Business Activity | Date Issued | Effective Date | Expiration Date |
|---|---|---|---|---|---|---|---|---|
| BUSINESS LICENSE | 2500887 | Issued | 4404 | Regulated Business License | 699 - Long Term Care Facility | 2023-01-31 | 2023-02-16 | 2025-02-15 |
| Inspection ID | Inspection Type | Inspection Date | License | Facility Type | Address | Risk | Results |
|---|---|---|---|---|---|---|---|
| 2602181 | Canvass Re-Inspection | 2024-09-05 | 2500887 | Long Term Care | 7433 N CLARK ST, CHICAGO, IL, 60626 | Risk 1 (High) | Pass w/ Conditions |
| 2600819 | Canvass | 2024-08-28 | 2500887 | Long Term Care | 7433 N CLARK ST, CHICAGO, IL, 60626 | Risk 1 (High) | Fail |
| 2576841 | Canvass | 2023-06-06 | 2500887 | Long Term Care | 7433 N CLARK ST, CHICAGO, IL, 60626 | Risk 1 (High) | Pass |
| 2564500 | Canvass Re-Inspection | 2022-09-29 | 2500887 | Long Term Care | 7433 N CLARK ST, CHICAGO, IL, 60626 | Risk 1 (High) | Pass |
| 2564116 | Canvass | 2022-09-22 | 2500887 | Long Term Care | 7433 N CLARK ST, CHICAGO, IL, 60626 | Risk 1 (High) | Fail |
| 2363210 | Canvass Re-Inspection | 2020-03-04 | 2500887 | Long Term Care | 7433 N CLARK ST, CHICAGO, IL, 60626 | Risk 1 (High) | Pass |
| 2362924 | Canvass | 2020-02-26 | 2500887 | Long Term Care | 7433 N CLARK ST, CHICAGO, IL, 60626 | Risk 1 (High) | Fail |
| 2268454 | Canvass | 2019-02-25 | 2500887 | Long Term Care | 7433 N CLARK ST, CHICAGO, IL, 60626 | Risk 1 (High) | Pass w/ Conditions |
| 2166351 | Canvass | 2018-04-19 | 2500887 | Long Term Care | 7433 N CLARK ST, CHICAGO, IL, 60626 | Risk 1 (High) | Pass |
| 1955467 | License | 2017-01-23 | 2500887 | Long Term Care | 7433 N CLARK ST, CHICAGO, IL, 60626 | Risk 1 (High) | Pass |
| Name | Type | Effective Date | Cancellation Date | Cancellation Type | Last Renewal Date |
|---|---|---|---|---|---|
| CLARK MANOR | Assumed name | 2016-07-27 | No data | No data | 2020-05-28 |
Date of last update: 23 Dec 2024
