Active NPI
Community Services for the Aging, Inc.
- Skilled Nursing Facility
- Spartanburg, SC
National Provider Identifier
1063409811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- NCF149
- Legal business name
- COMMUNITY SERVICES FOR THE AGING, INC.
- Practice address
- 340 Cedar Springs Road
Spartanburg, SC 29302 - Phone
- (864) 582-4175
- Fax
- (864) 583-2310
- NPI assigned
- Oct 5, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Wilson K. Dillard
- Title
- Administrator
- Phone
- (864) 582-4175
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NCF149 | SC | Primary |
Addresses
Primary practice location
340 Cedar Springs Road
Spartanburg, SC 29302
Mailing address
340 Cedar Springs Road
Spartanburg, SC 29302
Phone (864) 582-4175
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 291168 | Medicaid | SC |
Other names 1
- Mountainview Nursing Home
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110210000249 | SC | Part A Provider - Skilled Nursing Facility | 1759400542 | Practice locations: Spartanburg, SC |
Skilled nursing facility certification: CCN 425027
- Legal name
- COMMUNITY SERVICES FOR THE AGING, INC.
- Doing business as
- MOUNTAINVIEW NURSING HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Jan 1, 1967
- Last certification
- Nov 23, 2024
- Beds
- 132
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation
- Incorporated
- May 29, 1954 in SC
- Enrollment address
- 340 Cedar Springs Rd
Spartanburg, SC 29302-4637 - Nursing home name
- MOUNTAINVIEW NURSING HOME
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Mountainview Nursing Home
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Jan 1, 1967
- Medicare certification status
- Active
- Certified beds
- 132
- Penalties (3 years)
- 3
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D0722212 | Mountainview Nursing Home | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryLocations
340 Cedar Springs Rd
Spartanburg, SC 29302
Phone (864) 582-4175
Ownership & related parties
All disclosed owners & managing parties 15
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| E. Ralph Wessinger | Corporate Officer | Oct 9, 2012 | |
| Carol McCulloch | Corporate Director | Jan 1, 2021 | |
| Community Services for the Aging, Inc. | 5% Or Greater Direct Ownership Interest | Jul 1, 2010 | |
| Keith Sisk | Corporate Director | Jan 1, 2021 | |
| Matthew Summey | Corporate Director | Jan 1, 2021 | |
| Earl Miller | Corporate Director | Jan 1, 2021 | |
| Brenda Shirley | Corporate Director | Jul 1, 2010 | |
| Kevin Walters | Corporate Director | Nov 22, 1988 | |
| Richard Burgess | Corporate Director | Jan 1, 2021 | |
| Wilson Dillard | Corporate Director | Jul 1, 2010 | |
| W-2 Managing Employee | Jul 1, 2010 | ||
| Cynthia Matthews | Other | Jan 1, 2021 | |
| Sam Feemster | Corporate Director | Jan 1, 2021 | |
| Paul Burnett | Corporate Director | Jul 1, 2010 | |
| Leon Derek Herring | Corporate Director | Jan 1, 2021 | |
| Kelly Shippy-Gilbert | Corporate Director | Jul 1, 2010 |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128470400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1292803200000",
"number": "1063409811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 CEDAR SPRINGS ROAD",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "29302",
"telephone_number": "864-582-4175",
"fax_number": "864-583-2310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 CEDAR SPRINGS ROAD",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "29302",
"telephone_number": "864-582-4175",
"fax_number": "864-583-2310"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COMMUNITY SERVICES FOR THE AGING, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2005-10-05",
"last_updated": "2010-12-20",
"status": "A",
"authorized_official_last_name": "DILLARD",
"authorized_official_first_name": "WILSON",
"authorized_official_middle_name": "K.",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "864-582-4175",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "SC",
"license": "NCF149",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "291168",
"state": "SC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Mountainview Nursing Home",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Spartanburg, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.