FS Tenant Pool I Trust

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NCF829 Issued in SC

Legal business name

FS TENANT POOL I TRUST

Doing business as

Myrtle Beach Manor

Practice address

9547 Highway 17 North
Myrtle Beach, SC 29572-4039

Phone

(843) 449-5283

Fax

(843) 497-0880

NPI assigned

May 23, 2006

Last updated

Mar 27, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

FS TENANT POOL I TRUSTAs reported in NPPES

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

Authorized official

Name

Katherine E Potter

Title

President & Chief Executive Officer

Phone

(617) 796-8387

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MYRTLE BEACH MANOR Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

FS Tenant Pool I Trust

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tiffany L Jackson, O.D.

  • Optometrist
  • Wilmington, NC
  • NPI 1083837546
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553644800000",
    "number": "1841245313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9547 HIGHWAY 17 NORTH",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9547 HIGHWAY 17 NORTH",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724039",
            "telephone_number": "843-449-5283",
            "fax_number": "843-497-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FS TENANT POOL I TRUST",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FS TENANT POOL I TRUST",
        "enumeration_date": "2006-05-23",
        "last_updated": "2019-03-27",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "617-796-8387"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SC",
            "license": "NCF829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0829NF",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MYRTLE BEACH MANOR",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MYRTLE BEACH MANOR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer French, MA, LMFT
• Fresh Start Mental Health Services LLC
• Thomas D. Fritz
• Front Door Physicians
• Willa Fry, AU.D.
• FSQ Pharmacy Holdings, LLC (Expert Care Pharmacy)
• Karen J Fulwood, NP
• William A Funderburk Jr., DMD
• Cynthia Marie Funston
• Juliemar Bonilla Furr, FNP

• Skilled Nursing Facility in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Skilled Nursing Facility in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.