Extendicare, Inc.

Contacts

Phone	+1 334-793-1177
Fax	3346993948

Authorized person

Name	DAVID DENNIS
Role	CEO
Phone	3347931177

Taxonomy

Taxonomy Code	314000000X - Skilled Nursing Facility
License Number	N3501
State	AL
Is Primary	Yes

Other Provider Identifiers

Issuer	MEDICAID
Number	4757020S
State	AL

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1998-10-01
Business code	623000
Sponsor’s telephone number	3347931177
Plan sponsor’s address	950 S ST ANDREWS ST, DOTHAN, AL, 36301

Signature of

Role	Plan administrator
Date	2024-06-26
Name of individual signing	JAMES DENNIS

Inspection Type	Planned
Scope	Complete
Safety/Health	Health
Close Conference	2013-11-08
Emphasis	N: NURSING, P: NURSING
Case Closed	2014-02-19

Violation Items

Citation ID	01001
Citaton Type	Serious
Standard Cited	19100303 G01
Issuance Date	2014-01-28
Abatement Due Date	2014-02-07
Current Penalty	2250.0
Initial Penalty	3750.0
Final Order	2014-02-12
Nr Instances	2
Nr Exposed	1
Gravity	5
FTA Current Penalty	0.0
Citation text line	29 CFR 1910.303(g)(1): Sufficient access and working space was not provided and maintained about all electric equipment (operating at 600 volts, nominal, or less to ground) to permit ready and safe operation and maintenance of such equipment: a) Kitchen Pantry: On or about November 7, 2013: the employer failed to ensure that sufficient working space was maintained around the 240volt 3 phase electrical panel used to isolate electrical equipment in the kitchen area. b) Maintenance Building: On or about November 7, 2013: the employer failed to ensure that sufficient working space was maintained around the 240volt 3 phase electrical panel used to isolate electrical equipment in the maintenance building.

Loan Status Date	2021-05-08
Loan Status	Paid in Full
Loan Maturity in Months	24
SBA Guaranty Percentage	100
Loan Approval Amount (at origination)	1796512
Loan Approval Amount (current)	1796512
Undisbursed Amount	0
Franchise Name	-
Lender Location ID	3323
Servicing Lender Name	Troy Bank & Trust Company
Servicing Lender Address	1000 US Hwy 231 S, TROY, AL, 36081-3104
Rural or Urban Indicator	R
Hubzone	Y
LMI	Y
Business Age Description	Existing or more than 2 years old
Project Address	DOTHAN, HOUSTON, AL, 36301-3684
Project Congressional District	AL-02
Number of Employees	290
NAICS code	623110
Borrower Race	White
Borrower Ethnicity	Not Hispanic or Latino
Business Type	Corporation
Originating Lender ID	3323
Originating Lender Name	Troy Bank & Trust Company
Originating Lender Address	TROY, AL
Gender	Male Owned
Veteran	Veteran
Forgiveness Amount	1814526.34
Forgiveness Paid Date	2021-04-08