NPIMap

Organization Active NPI

Palmetto Lake City Operating LLC

Doing business as Lake City Healthcare Center

  • Skilled Nursing Facility
  • Scranton, SC
National Provider Identifier
1245314699
Registry record updated Dec 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NCF-846 Issued in SC
Legal business name
PALMETTO LAKE CITY OPERATING LLC
Doing business as
Lake City Healthcare Center
Practice address
1940 Boyd Rd
Scranton, SC 29591-5835
Phone
(843) 389-9201
Fax
(843) 389-9202
NPI assigned
Oct 24, 2006
Last updated
Dec 30, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2014

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

Authorized official

Name
Susan Goldsmith
Title
Administrator
Phone
(843) 389-9201

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NCF-846 SC Primary

Addresses

Primary practice location

1940 Boyd Rd
Scranton, SC 29591-5835

Mailing address

1940 Boyd Rd
Scranton, SC 29591-5835
Phone (843) 389-9201

Other identifiers 1

IdentifierTypeStateIssuer
0928NFMedicaidSC

Other names 1

  • Lake City 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
O20061129000190 SC Part A Provider - Skilled Nursing Facility 0547268575 Practice locations: Scranton, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245314699. Details of each certification follow.

Skilled nursing facility certification: CCN 425149

Legal name
PALMETTO LAKE CITY OPERATING LLC
Doing business as
LAKE CITY SCRANTON HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 21, 1983
Last certification
May 23, 2024
Beds
88
Ownership / control type
Corporation
Multi-facility organization
Fundamental Clinical Operations
Organization structure
LLCProprietary
Incorporated
Aug 30, 2006 in DE
Enrollment address
1940 Boyd Rd
Scranton, SC 29591-5835
Nursing home name
LAKE CITY SCRANTON HEALTHCARE CENTER
Affiliated entity
FUNDAMENTAL HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lake City Scranton Healthcare CenterCCN 425149 · 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 - Corporation
Certified
Jul 21, 1983
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8882.4 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
42D0899388Lake City-Scranton Healthcare1940 Boyd Street, Scranton, SC 29591Certificate of waiverMar 28, 2027

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%
Benjamin a Prince Individual W-2 Managing EmployeeAdministrator Nov 29, 2021
Murray Forman Individual 5% Or Greater Indirect Ownership Interest Aug 22, 2006
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 2

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": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419897600000",
    "number": "1245314699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 BOYD RD",
            "city": "SCRANTON",
            "state": "SC",
            "postal_code": "295915835",
            "telephone_number": "843-389-9201",
            "fax_number": "843-389-9202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1940 BOYD RD",
            "city": "SCRANTON",
            "state": "SC",
            "postal_code": "295915835",
            "telephone_number": "843-389-9201",
            "fax_number": "843-389-9202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO LAKE CITY OPERATING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2014-12-30",
        "status": "A",
        "authorized_official_last_name": "GOLDSMITH",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "843-389-9201"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SC",
            "license": "NCF-846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0928NF",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake City Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Scranton, SC

Sources for this page

Verify at the official NPI Registry.