NPIMap

Organization Active NPI

Brightwater Retirement, LLC

  • Skilled Nursing Facility
  • Myrtle Beach, SC
National Provider Identifier
1407090434
Registry record updated Jan 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NCF-0955 Issued in SC
Legal business name
BRIGHTWATER RETIREMENT, LLC
Practice address
101 Brightwater Dr
Myrtle Beach, SC 29579-8268
Phone
(843) 903-8300
Fax
(843) 236-1644
NPI assigned
Apr 21, 2009
Last updated
Jan 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2016

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

Authorized official

Name
Mr. Gary Ventola
Title
Sr. VP of Administration
Phone
(704) 246-1610

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X
Assisted Living Facility 310400000X CRC-1489 SC
Skilled Nursing Facility 314000000X NCF-0955 SC Primary

Addresses

Primary practice location

101 Brightwater Dr
Myrtle Beach, SC 29579-8268

Mailing address

101 Brightwater Dr
Myrtle Beach, SC 29579-8268
Phone (843) 903-8300

Other names 1

  • Brightwater Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090827000313 SC Part A Provider - Skilled Nursing Facility 0941355986 Practice locations: Myrtle Beach, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407090434. Details of each certification follow.

Skilled nursing facility certification: CCN 425395

Legal name
BRIGHTWATER RETIREMENT, LLC
Doing business as
THE RETREAT AT BRIGHTWATER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 23, 2009
Last certification
Apr 30, 2025
Beds
67
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Maxwell Group
Organization structure
LLCProprietary
Incorporated
Jul 13, 2007 in SC
Enrollment address
101 Brightwater Dr
Myrtle Beach, SC 29579-8275
Nursing home name
BRIGHTWATER SKILLED NURSING CENTER
Affiliated entity
SENIOR LIVING COMMUNITIES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Brightwater Skilled Nursing CenterCCN 425395 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 23, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6750.8 residents per day on average
Chain
Senior Living Communities9 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Brightwater2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Timothy Bruce Bradford Individual Adp of the SNF Mar 7, 2025
Benjamin M. Thompson Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2021 25%
Corporate OfficerCeo Jul 1, 2022
Operational/Managerial Control Jul 1, 2022
Joshua E. Thompson Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2021 25%
Donald Thompson Individual 5% Or Greater Indirect Ownership Interest Jul 20, 2009 50%
Corporate DirectorManager Jul 20, 2009
Managing Control - Governing BodyManager Jul 20, 2009
Senior Living Commuities LLC Organization, Charlotte, NC LLC 5% Or Greater Direct Ownership Interest Jul 20, 2009 100%
Organization, Murfreesboro, TN Real estate investment trust (REIT) Adp of the SNF Dec 1, 2014
Matthew Arledge Individual Adp of the SNF Mar 5, 2025
Maxwell Group, Inc. Organization, Charlotte, NC Management services company Operational/Managerial Control Nov 14, 2007
Adp of the SNF Jan 30, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 10

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": "1240272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452729600000",
    "number": "1407090434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BRIGHTWATER DR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295798268",
            "telephone_number": "843-903-8300",
            "fax_number": "843-236-1644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BRIGHTWATER DR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295798268",
            "telephone_number": "843-903-8300",
            "fax_number": "843-236-1644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHTWATER RETIREMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-21",
        "last_updated": "2016-01-14",
        "status": "A",
        "authorized_official_last_name": "VENTOLA",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "SR. VP OF ADMINISTRATION",
        "authorized_official_telephone_number": "704-246-1610",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "SC",
            "license": "CRC-1489",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SC",
            "license": "NCF-0955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brightwater",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.