Thi of South Carolina at Greenwood, LLC
Organization Active NPI Skilled Nursing Facility · Greenwood, SC
NPI 1770670960 · NPPES record last updated Apr 7, 2008
Key facts
- NPI
- 1770670960
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- THI OF SOUTH CAROLINA AT GREENWOOD, LLC
- Practice address
- 1415 Parkway
Greenwood, SC 29646-4044 - Phone
- (864) 227-9500
- Fax
- (864) 227-9488
- NPI assigned
- Oct 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Edith Goforth
- Title
- President
- Phone
- (864) 227-9500
Facilities with the same owner 40
Affiliated clinicians 1
-
Daniel R Crow, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Magnolia Manor - Greenwood
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Mar 1, 1989
- Medicare certification status
- Active
- Certified beds
- 88 · 83.3 residents per day on average
- Chain
- Fundamental Healthcare
- Penalties (3 years)
- 2 · fines totaling $13,075
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D0942428 | Magnolia Manor of Greenwood | Certificate of waiver | Mar 10, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Skilled nursing facility certification: CCN 425172
- Legal name
- THI OF SOUTH CAROLINA AT GREENWOOD, LLC
- Doing business as
- MAGNOLIA MANOR - GREENWOOD
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 1, 1989
- Last certification
- Dec 1, 2023
- Beds
- 88
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- THI OF SOUTH CAROLINA, LLC
- Organization structure
- LLC · Proprietary
- Incorporated
- May 19, 2003 in DE
- Enrollment address
- 1415 Parkway
Greenwood, SC 29646-4044 - Nursing home name
- MAGNOLIA MANOR - GREENWOOD
- Affiliated entity
- FUNDAMENTAL HEALTHCARE
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Edith Goforth |
Corporate Officer |
Jul 6, 2006 | |
| W-2 Managing Employee |
Jul 6, 2006 | ||
| Thi of South Carolina, LLC |
5% Or Greater Direct Ownership Interest | Aug 30, 2003 | 100% |
| Murray Forman |
5% Or Greater Indirect Ownership Interest | Mar 28, 2006 | 100% |
| Valerie Leary |
Corporate Officer |
Jan 31, 2005 | |
| Thi of Baltimore, Inc. |
5% Or Greater Indirect Ownership Interest | Aug 30, 2003 | 100% |
| Hunt Valley Holdings LLC |
5% Or Greater Indirect Ownership Interest | Mar 28, 2006 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040706000565 | SC | Part a Provider - Skilled Nursing Facility | 8628055852 | Practice locations: Greenwood, SC |
National Provider Directory
Locations
1415 Parkway
Greenwood, SC 29646
Phone (864) 227-9500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
1415 Parkway
Greenwood, SC 29646-4044
Mailing address
930 Ridgebrook Rd
Sparks, MD 21152-9390
Phone (410) 773-1000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0866NF | Medicaid | SC |
Other names
- Magnolia Manor - Greenwood, Inc.
Other providers in Greenwood, SC
- The Medicine Dropper, Inc.
- The Nest Home Health Care, LLC
- The Palmetto Clinics, LLC
- The Speech Connection
- The Surgery Center at Self Memorial Hospital, LLC
- Jeffrey Bernard Thomas
- Krystal Thomas
- Letricia Thomas
- Trieneke Rapp Thomas
- Denise Walker Thompson
All providers in Greenwood, 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 Apr 7, 2008. 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.