NPIMap

Organization Active NPI

Simpsonville Community Healthcare, LLC

Doing business as Simpsonville Post Acute

  • Skilled Nursing Facility
  • Simpsonville, SC
National Provider Identifier
1083387336
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SIMPSONVILLE COMMUNITY HEALTHCARE, LLC
Doing business as
Simpsonville Post Acute
Practice address
807 SE Main St
Simpsonville, SC 29681-7150
Phone
(864) 963-6069
NPI assigned
Jul 30, 2021
Last updated
Aug 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Mitchell
Title
Secretary
Phone
(385) 988-3319

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

807 SE Main St
Simpsonville, SC 29681-7150

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Simpsonville Post Acute Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220210002884 SC Part A Provider - Skilled Nursing Facility 8022401215 Practice locations: Simpsonville, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083387336. Details of each certification follow.

Skilled nursing facility certification: CCN 425112

Legal name
SIMPSONVILLE COMMUNITY HEALTHCARE, LLC
Doing business as
SIMPSONVILLE POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 16, 1977
Last certification
Aug 28, 2024
Beds
132
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS
Organization structure
LLCProprietary
Incorporated
Jun 29, 2021 in SC
Enrollment address
807 SE Main St
Simpsonville, SC 29681-7150
Nursing home name
SIMPSONVILLE POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Simpsonville Post AcuteCCN 425112 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 16, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
132125.2 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
1Fines totaling $9,710

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0709917Simpsonville Post Acute807 South East Main St, Simpsonville, SC 29681Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Providence Group Inc Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 29, 2021 100%
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Palmetto Community Healthcare, LLC Organization, Farmington, UT Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Jun 29, 2021 100%
Joshua O Jergensen Individual Corporate OfficerPresident Jan 1, 2024
Henry Igdal Individual Contracted Managing EmployeeMD; Sep 1, 2021
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Cheyne Lester Individual W-2 Managing EmployeeAd; Jun 30, 2023
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 80

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 80

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1083387336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 N UNIVERSITY AVE",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 SE MAIN ST",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296817150",
            "telephone_number": "864-963-6069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMPSONVILLE COMMUNITY HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-30",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "385-988-3319"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Simpsonville Post Acute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Simpsonville Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Simpsonville, SC

Sources for this page

Verify at the official NPI Registry.