Thi of South Carolina at Camp Care, LLC
Organization Active NPI Skilled Nursing Facility · Inman, SC
NPI 1154418333 · NPPES record last updated Sep 18, 2013
Key facts
- NPI
- 1154418333
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- THI OF SOUTH CAROLINA AT CAMP CARE, LLC
- Practice address
- 59 Blackstock Rd
Inman, SC 29349-1827 - Phone
- (864) 472-2028
- Fax
- (864) 472-6901
- NPI assigned
- Oct 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Wadette Cothran
- Title
- President
- Phone
- (864) 472-2028
Facilities with the same owner 40
Medicare Care Compare: Nursing home
- Listed as
- Lake Emory Post Acute Care
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Feb 15, 1991
- Medicare certification status
- Active
- Certified beds
- 88 · 85.1 residents per day on average
- Chain
- Fundamental Healthcare
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 3 · fines totaling $27,147
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D0939938 | Lake Emory Post Acute Care | Certificate of waiver | Feb 2, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Skilled nursing facility certification: CCN 425303
- Legal name
- THI OF SOUTH CAROLINA AT CAMP CARE, LLC
- Doing business as
- LAKE EMORY POST ACUTE CARE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Feb 15, 1991
- Last certification
- Jul 18, 2024
- Beds
- 88
- Ownership / control type
- Corporation
- Multi-facility organization
- Fundamental
- Organization structure
- LLC · Proprietary
- Incorporated
- May 19, 2003 in DE
- Enrollment address
- 59 Blackstock Rd
Inman, SC 29349-1827 - Nursing home name
- LAKE EMORY POST ACUTE CARE
- Affiliated entity
- FUNDAMENTAL HEALTHCARE
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Thi of South Carolina, LLC |
5% Or Greater Direct Ownership Interest | Aug 30, 2003 | 100% |
| Murray Forman |
5% Or Greater Indirect Ownership Interest | Mar 28, 2006 | 100% |
| Jeanette Blankenship |
Corporate Officer |
May 30, 2019 | |
| W-2 Managing Employee |
May 30, 2019 | ||
| Thi of Baltimore, Inc. |
5% Or Greater Indirect Ownership Interest | Aug 30, 2003 | 100% |
| Hunt Valley Holdings LLC |
5% Or Greater Indirect Ownership Interest | Mar 28, 2006 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040713000134 | SC | Part a Provider - Skilled Nursing Facility | 6709864085 | Practice locations: Inman, SC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
59 Blackstock Rd
Inman, SC 29349-1827
Mailing address
920 Ridgebrook Rd
Sparks, MD 21152-9390
Phone (410) 773-1000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0862NF | Medicaid | SC |
Other names
- Lake Emory Post Acute Care
Other providers in Inman, SC
- Louise W Swindler
- Benjamin Thomas Taylor
- Sharrell Taylor
- The Wellness Place
- Therapy Thoughts & Coaching, LLC
- Thi of South Carolina at Inman, LLC
- Thi of South Carolina at Magnolia Manorinman, LLC
- Thi of South Carolina Golden Age at Inman, LLC
- Nicolas Jordan Thomas
- Megan Tokar
All providers in Inman, SC · Skilled Nursing Facility in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.