NPIMap

Organization Active NPI

Thi of South Carolina at Spartanburg, LLC

Doing business as Magnolia Manor of Spartanburg

  • Skilled Nursing Facility
  • Spartanburg, SC
National Provider Identifier
1215024401
Registry record updated Apr 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
THI OF SOUTH CAROLINA AT SPARTANBURG, LLC
Doing business as
Magnolia Manor of Spartanburg
Practice address
375 Serpentine Dr
Spartanburg, SC 29303-3026
Phone
(864) 585-0218
Fax
(864) 594-5122
NPI assigned
Oct 7, 2006
Last updated
Apr 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2008

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

Authorized official

Name
Robert Hilsen
Title
President
Phone
(864) 585-0218

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

375 Serpentine Dr
Spartanburg, SC 29303-3026

Mailing address

930 Ridgebrook Rd
Sparks, MD 21152-9390
Phone (410) 773-1000

Other names 1

  • Magnolia Manor of Spartanburg Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040623001123 SC Part A Provider - Skilled Nursing Facility 7315922275 Practice locations: Spartanburg, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215024401. Details of each certification follow.

Skilled nursing facility certification: CCN 425091

Legal name
THI OF SOUTH CAROLINA AT SPARTANBURG, LLC
Doing business as
MAGNOLIA MANOR - SPARTANBURG
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1978
Last certification
May 20, 2025
Beds
95
Ownership / control type
Corporation
Multi-facility organization
FUNDAMENTAL
Organization structure
LLCProprietary
Incorporated
May 19, 2003 in DE
Enrollment address
375 Serpentine Dr
Spartanburg, SC 29303-3026
Nursing home name
MAGNOLIA MANOR - SPARTANBURG
Affiliated entity
FUNDAMENTAL HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Magnolia Manor - SpartanburgCCN 425091 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Apr 1, 1978
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9591.9 residents per day on average
Chain
Fundamental Healthcare66 facilities in the chain
Penalties (3 years)
1Fines totaling $12,054

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
42D0889276Magnolia Manor-Spartanburg Inc375 Serpentine Drive, Spartanburg, SC 29303Certificate of waiverMay 21, 2027

National Provider Directory

National Provider Directory

Locations

375 Serpentine Dr
Spartanburg, SC 29303
Phone (864) 585-0218

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Angela Sherbert Individual Corporate OfficerAdministrator and President Jun 24, 2019
W-2 Managing EmployeeAdministrator Jun 24, 2019
Thi of South Carolina, LLC Organization, Greenwood, SC For-profit 5% Or Greater Direct Ownership Interest Aug 30, 2003 100%
Murray Forman Individual 5% Or Greater Direct Ownership Interest Mar 28, 2006 100%
Corporate Director May 11, 2006
Kimberly Quinn Individual Corporate OfficerVP Treasurer Jul 6, 2006
Thi of Baltimore, Inc. Organization, Sparks, MD For-profit 5% Or Greater Indirect Ownership Interest Aug 30, 2003 100%
Hunt Valley Holdings LLC Organization, Sparks, MD For-profit 5% Or Greater Indirect Ownership Interest Mar 28, 2006 100%

Facilities with the same owner 40

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

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1160179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207526400000",
    "number": "1215024401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 RIDGEBROOK RD",
            "city": "SPARKS",
            "state": "MD",
            "postal_code": "211529390",
            "telephone_number": "410-773-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 SERPENTINE DR",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033026",
            "telephone_number": "864-585-0218",
            "fax_number": "864-594-5122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THI OF SOUTH CAROLINA AT SPARTANBURG, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-07",
        "last_updated": "2008-04-07",
        "status": "A",
        "authorized_official_last_name": "HILSEN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "864-585-0218"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Manor of Spartanburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spartanburg, SC

Sources for this page

Verify at the official NPI Registry.