Woodruff Manor
Organization Active NPI Skilled Nursing Facility · Woodruff, SC
NPI 1437668019 · NPPES record last updated Jun 1, 2021
Key facts
- NPI
- 1437668019
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- WOODRUFF MANOR
- Practice address
- 1114 E Georgia Rd
Woodruff, SC 29388 - Phone
- (864) 476-7092
- Fax
- (864) 476-0753
- NPI assigned
- Sep 26, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC.
Authorized official
- Name
- Kenneth Meike
- Title
- Chief Financial Officer
- Phone
- (864) 560-6000
Owners & managing parties with NPI records 3
-
Kurtis Jon Melin, MD
Member of 1
Facilities with the same owner 19
Affiliated clinicians 1
-
Haritha Boppana, MD
Medicare Care Compare: Nursing home
- Listed as
- Woodruff Manor
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- Government - Hospital district
- Certified
- Jan 5, 1990
- Medicare certification status
- Active
- Certified beds
- 88 · 82.0 residents per day on average
- Penalties (3 years)
- 3 · fines totaling $33,602
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Skilled nursing facility certification: CCN 425179
- Legal name
- WOODRUFF MANOR
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 5, 1990
- Last certification
- Oct 18, 2024
- Beds
- 88
- Ownership / control type
- Hospital District
- Multi-facility organization
- Spartanburg Regional Health Service District, INC
- Organization structure
- Other · Non-profit
- Enrollment address
- 1114 E Georgia Rd
Woodruff, SC 29388-9350 - Nursing home name
- WOODRUFF MANOR
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Christopher Terrell |
Operational/Managerial Control | May 1, 2018 | |
| Adp of the SNF | Jan 31, 2025 | ||
| Apella Health Management Inc |
Operational/Managerial Control | Jan 1, 2019 | |
| Adp of the SNF | Jan 31, 2025 | ||
| Direct Ownership Interest | Jan 1, 2019 | ||
| Elmer B Holstien |
Corporate Officer |
Aug 1, 2011 | |
| Spartanburg Regional Health Services District Inc |
5% Or Greater Direct Ownership Interest | Sep 29, 2017 | 100% |
| Operational/Managerial Control | Sep 29, 2017 | 100% | |
| Kurtis Jon Melin |
Adp of the SNF | Jan 31, 2025 | |
| Charles E Morrow |
Corporate Officer |
Dec 4, 2023 | |
| Bruce a Davis |
Corporate Officer |
Jan 25, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180315001836 | SC | Part a Provider - Skilled Nursing Facility | 5092077867 | Practice locations: Woodruff, SC |
National Provider Directory
- Part of
- Spartanburg Regional Health Services District Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
1114 E Georgia Rd
Woodruff, SC 29388
Mailing address
PO Box 2168
Spartanburg, SC 29304-2168
Phone (864) 560-4304
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NF1085 | Medicaid | SC | |
| UPLN17 | Medicaid | SC | |
| 42-5179 | Other | SC | MEDICARE PIN |
Other names
- Woodruff Manor
Other providers in Woodruff, SC
- Shawna Monee White
- Sandra S Williams
- Woodruff Family Dentistry
- Woodruff Family Medicine LLC
- Woodruff Family Pharmacy LLC
- Woodruff Manor, LLC
- Jessica Duncan Worthington
- Stephanie L Younger
All providers in Woodruff, 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 Jun 1, 2021. 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.