NPIMap

Organization Active NPI

Wellmore of Tega Cay, LLC

  • Skilled Nursing Facility
  • Tega Cay, SC
National Provider Identifier
1619427697
Registry record updated Jun 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NCF-0988 Issued in SC
Legal business name
WELLMORE OF TEGA CAY, LLC
Practice address
111 Wellmore Dr
Tega Cay, SC 29708-0124
Phone
(704) 612-0363
NPI assigned
Oct 13, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2017

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

Authorized official

Name
Mr. Donald O Thompson Jr.
Title
Ceo
Phone
(704) 246-1620

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X
Skilled Nursing Facility 314000000X NCF-0988 SC Primary

Addresses

Primary practice location

111 Wellmore Dr
Tega Cay, SC 29708-0124

Mailing address

3530 Toringdon Way
Suite 204
Charlotte, NC 28277-3431
Phone (704) 246-1620

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161122000542 SC Part A Provider - Skilled Nursing Facility 4385952274 Practice locations: Tega Cay, SC

Skilled nursing facility certification: CCN 425407

Legal name
WELLMORE OF TEGA CAY LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Apr 18, 2016
Last certification
Apr 3, 2025
Beds
60
Ownership / control type
Corporation
Multi-facility organization
MAXWELL GROUP SENIOR LIVING COMMUNITIE
Most recent change of ownership
Sep 1, 2016
Organization structure
LLCProprietary
Incorporated
Mar 6, 2012 in SC
Enrollment address
111 Wellmore Dr
Tega Cay, SC 29708-0124
Nursing home name
THE LODGE AT WELLMORE- TEGA CAY

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Lodge At Wellmore- Tega CayCCN 425407
Overall star rating
5 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare
Ownership
For profit - Corporation
Certified
Apr 18, 2016
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6055.3 residents per day on average
Penalties (3 years)
3Fines totaling $35,403

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
42D2100731Wellmore of Tega Cay-the Lodge111 Wellmore Drive, Fort Mill, SC 29708Certificate of waiverAug 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
The Lodge at Wellmore Tega Cay2 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.

  • We
    • Skilled Nursing Facility
    • Tega Cay, SC
    • NPI 1962892893
    NPD tax ID

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
Benjamin M. Thompson Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2021
Operational/Managerial Control Jul 1, 2022
Joshua E. Thompson Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2021
Jasmine Richard Individual Adp of the SNF Nov 18, 2025
Organization, Orlando, FL Real estate investment trust (REIT) Adp of the SNF Sep 1, 2016
Donald Thompson Individual 5% Or Greater Indirect Ownership Interest Mar 6, 2012
Dana P Giarrizzi Individual Adp of the SNF Nov 18, 2025
Wellmore LLC Organization, Charlotte, NC Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Mar 6, 2012 100%
Maxwell Group, Inc. Organization, Charlotte, NC Management services company Operational/Managerial Control Sep 1, 2016
Adp of the SNF Feb 2, 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 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": "1476316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497830400000",
    "number": "1619427697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3530 TORINGDON WAY",
            "address_2": "SUITE 204",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282773431",
            "telephone_number": "704-246-1620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 WELLMORE DR",
            "city": "TEGA CAY",
            "state": "SC",
            "postal_code": "297080124",
            "telephone_number": "704-612-0363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLMORE OF TEGA CAY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-13",
        "last_updated": "2017-06-19",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-246-1620",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SC",
            "license": "NCF-0988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tega Cay, SC

Sources for this page

Verify at the official NPI Registry.