NPIMap

Organization Active NPI

Palmetto Jolley Acres Operating LLC

Doing business as Jolley Acres Healthcare Center

  • Skilled Nursing Facility
  • Orangeburg, SC
National Provider Identifier
1093897639
Registry record updated Sep 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NCF-0929 Issued in SC
Legal business name
PALMETTO JOLLEY ACRES OPERATING LLC
Doing business as
Jolley Acres Healthcare Center
Practice address
1180 Wolfe TRL
Orangeburg, SC 29115-7339
Phone
(803) 534-1001
NPI assigned
Oct 20, 2006
Last updated
Sep 20, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2011

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

Authorized official

Name
Deana Houser
Title
Administrator
Phone
(803) 534-1001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NCF-0929 SC Primary

Addresses

Primary practice location

1180 Wolfe TRL
Orangeburg, SC 29115-7339

Mailing address

1180 Wolfe TRL
Orangeburg, SC 29115-7339

Other identifiers 1

IdentifierTypeStateIssuer
NCF-0929MedicaidSC

Other names 1

  • Jolley Acres Healthcare Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061129000154 SC Part A Provider - Skilled Nursing Facility 6305844325 Practice locations: Orangeburg, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093897639. Details of each certification follow.

Skilled nursing facility certification: CCN 425055

Legal name
PALMETTO JOLLEY ACRES OPERATING LLC
Doing business as
JOLLEY ACRES HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1980
Last certification
Sep 19, 2024
Beds
60
Ownership / control type
Limited Liability Corporation
Multi-facility organization
FUNDAMENTAL LONG TERM CARE
Organization structure
LLCProprietary
Incorporated
Sep 29, 2006 in DE
Enrollment address
1180 Wolfe TRL
Orangeburg, SC 29115-7339
Nursing home name
JOLLEY ACRES HEALTHCARE CENTER
Affiliated entity
FUNDAMENTAL HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Jolley Acres Healthcare CenterCCN 425055 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 1, 1980
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6056.9 residents per day on average
Chain
Fundamental Healthcare66 facilities in the chain

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
42D0857377Jolley Acres Healthcare Center1180 Wolfe Trail, Orangeburg, SC 29115Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Palmetto Health Care LLC Organization, Sparks, MD LLC 5% Or Greater Direct Ownership Interest Aug 22, 2006 100%
Gwendolyn a Robinson Individual W-2 Managing EmployeeAdministrator Jan 1, 2023
Murray Forman Individual 5% Or Greater Indirect Ownership Interest Aug 22, 2016 99%
Kenneth a Tabler Individual Corporate OfficerPresident Aug 15, 2015

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316476800000",
    "number": "1093897639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 WOLFE TRL",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291157339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 WOLFE TRL",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291157339",
            "telephone_number": "803-534-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO JOLLEY ACRES OPERATING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2011-09-20",
        "status": "A",
        "authorized_official_last_name": "HOUSER",
        "authorized_official_first_name": "DEANA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "803-534-1001"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SC",
            "license": "NCF-0929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NCF-0929",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jolley Acres Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orangeburg, SC

Sources for this page

Verify at the official NPI Registry.