NPIMap

Organization Active NPI

Thi of South Carolina at Magnolia Manorinman, LLC

Doing business as Magnolia Manor - Inman

  • Skilled Nursing Facility
  • Inman, SC
National Provider Identifier
1689761876
Registry record updated Apr 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
THI OF SOUTH CAROLINA AT MAGNOLIA MANORINMAN, LLC
Doing business as
Magnolia Manor - Inman
Practice address
63 Blackstock Rd
Inman, SC 29349-1835
Phone
(864) 472-9055
Fax
(864) 472-2619
NPI assigned
Oct 7, 2006
Last updated
Apr 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2008

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

Authorized official

Name
Dale Lyles
Title
President
Phone
(864) 472-9055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

63 Blackstock Rd
Inman, SC 29349-1835

Mailing address

930 Ridgebrook Rd
Sparks, MD 21152-9390
Phone (410) 773-1000

Other identifiers 1

IdentifierTypeStateIssuer
0863NFMedicaidSC

Other names 1

  • Magnolia Manor - Inman Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040819001038 SC Part A Provider - Skilled Nursing Facility 0749254431 Practice locations: Inman, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689761876. Details of each certification follow.

Skilled nursing facility certification: CCN 425032

Legal name
THI OF SOUTH CAROLINA AT MAGNOLIA MANORINMAN, LLC
Doing business as
MAGNOLIA MANOR - INMAN
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1967
Last certification
Feb 23, 2024
Beds
176
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Fundamental
Organization structure
LLCProprietary
Incorporated
May 19, 2003 in DE
Enrollment address
63 Blackstock Rd
Inman, SC 29349-1835
Nursing home name
MAGNOLIA MANOR - INMAN
Affiliated entity
FUNDAMENTAL HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Magnolia Manor - InmanCCN 425032 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 1, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
176168.1 residents per day on average
Chain
Fundamental Healthcare66 facilities in the chain
Special focus status
SFF Candidate
Penalties (3 years)
6Fines totaling $94,778

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
42D0926190Thi of South Carolina at Magnolia Manor63 Blackstock Road, Inman, SC 29349Certificate of waiverMar 16, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Thi of South Carolina, LLC Organization, Greenwood, SC For-profit 5% Or Greater Direct Ownership Interest Aug 30, 2003 100%
Murray Forman Individual 5% Or Greater Indirect Ownership Interest Mar 28, 2006 100%
Larry Pearson Individual Corporate OfficerPresident Jan 30, 2020
W-2 Managing EmployeeAdministrator Jan 30, 2020
Connie Stone Individual Corporate OfficerVP Treasurer Secretary Nov 1, 2010
Thi of Baltimore, Inc. Organization, Sparks, MD For-profit 5% Or Greater Indirect Ownership Interest Aug 30, 2003 100%
Hunt Valley Holdings LLC Organization, Sparks, MD For-profit 5% Or Greater Indirect Ownership Interest Mar 28, 2006 100%

Facilities with the same owner 40

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 40

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1160179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207526400000",
    "number": "1689761876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 RIDGEBROOK RD",
            "city": "SPARKS",
            "state": "MD",
            "postal_code": "211529390",
            "telephone_number": "410-773-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 BLACKSTOCK RD",
            "city": "INMAN",
            "state": "SC",
            "postal_code": "293491835",
            "telephone_number": "864-472-9055",
            "fax_number": "864-472-2619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THI OF SOUTH CAROLINA AT MAGNOLIA MANORINMAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-07",
        "last_updated": "2008-04-07",
        "status": "A",
        "authorized_official_last_name": "LYLES",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "864-472-9055"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0863NF",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Manor - Inman",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Inman, SC

Sources for this page

Verify at the official NPI Registry.