Thi of South Carolina at Spartanburg, LLC
Organization Active NPI Skilled Nursing Facility · Spartanburg, SC
NPI 1215024401 · NPPES record last updated Apr 7, 2008
Key facts
- NPI
- 1215024401
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- THI OF SOUTH CAROLINA AT SPARTANBURG, LLC
- Practice address
- 375 Serpentine Dr
Spartanburg, SC 29303-3026 - Phone
- (864) 585-0218
- Fax
- (864) 594-5122
- NPI assigned
- Oct 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Robert Hilsen
- Title
- President
- Phone
- (864) 585-0218
Facilities with the same owner 40
Medicare Care Compare: Nursing home
- Listed as
- Magnolia Manor - Spartanburg
- 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
- Active
- Certified beds
- 95 · 91.9 residents per day on average
- Chain
- Fundamental Healthcare
- Penalties (3 years)
- 1 · fines totaling $12,054
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D0889276 | Magnolia Manor-Spartanburg Inc | Certificate of waiver | May 21, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
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
- LLC · Proprietary
- 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
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Angela Sherbert |
Corporate Officer |
Jun 24, 2019 | |
| W-2 Managing Employee |
Jun 24, 2019 | ||
| Thi of South Carolina, LLC |
5% Or Greater Direct Ownership Interest | Aug 30, 2003 | 100% |
| Murray Forman |
5% Or Greater Direct Ownership Interest | Mar 28, 2006 | 100% |
| Corporate Director | May 11, 2006 | ||
| Kimberly Quinn |
Corporate Officer |
Jul 6, 2006 | |
| 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 |
|---|---|---|---|---|
| O20040623001123 | SC | Part a Provider - Skilled Nursing Facility | 7315922275 | Practice locations: Spartanburg, SC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0867NF | Medicaid | SC |
Other names
- Magnolia Manor of Spartanburg
Other providers in Spartanburg, SC
- The Vitality Co.
- Benjamin David Theobald
- Therapeutic Hands LLC
- Therapeutic Solutions, Inc.
- Thi of South Carolina at Magnolia Place at Spartanburg, LLC
- Thomas J. Haviland, OD, PC
- Thomas Opticians Inc
- Thomas Patrick
- Audrey Thomas-Huff
- Alexa Rouse Thomas
All providers in Spartanburg, 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 Apr 7, 2008. 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.