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May 1, 2013

South Carolina Department of Health & Environmental Control Division of Health Licensing

County: Chesterfield Facility Type: Adult Day Care

County/Ownership Type Mailing/Billing Address Licensee License Nbr/Expiration Date Chesterfield / Corporation PO BOX 186 CHERAW, SC 29520-0186

TRI-COUNTY ADULT DAY SERVICES INC

Facility Name Location Street Location City, State Administrator/Phone TRI-COUNTY ADULT DAY HEALTH SERVICES 169 CALVARY RD CHERAW, SC 29520-7106 FAC.#:843-921-9451 SCOTT RN, CAROLYN E PH#: 843-537-7592 Facility Email:

[email protected]

Licensed Units

60

Number of Participants: Totals For Facility/License Type: Adult Day Care Number of Activities/Facilities licensed: 1

ADC-0282 / 01/31/2014 60

Number Licensed Units:

60

1

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May 1, 2013

South Carolina Department of Health & Environmental Control Division of Health Licensing

County: Chesterfield Facility Type: Community Residential Care Facility

County/Ownership Type Mailing/Billing Address Licensee License Nbr/Expiration Date Chesterfield / County 1615 STATE RD CHERAW, SC 29520-5107

CHESCO SERVICES

Facility Name Location Street Location City, State Administrator/Phone CHARLES M INGRAM SR COMMUNITY RESIDENCE 1615 STATE RD CHERAW, SC 29520-5107 FAC.#:843-537-5122 PETERKIN, MARGARETE PH#: 843-623-9016 Facility Email:

[email protected]

Licensed Units

8

CRC-1440 / 05/31/2013 Alzheimer Unit: No Chesterfield / County 817 E MAIN ST CHESTERFIELD, SC

CHESCO SERVICES

Alzheimer Care:No

Max # Resident:0

Max # Beds: 0 8

Certifications:None CHESTERFIELD COMMUNITY RESIDENCE 817 E MAIN ST CHESTERFIELD, SC 29709-1807 FAC.#:843-623-6586 PETERKIN, MARGARETE PH#: 843-623-9016 Facility Email:

[email protected]

29709-0151

CRC-1441 / 05/31/2013 Alzheimer Unit: No Max # Beds: 0 58

Alzheimer Care:No Certifications:None PAGELAND CARE FACILITY 206 S GUM ST

Max # Resident:0

Chesterfield / Corporation PO BOX 697 LANCASTER, SC 29721-0697

FUNDERBURK ASSOCIATES INC

PAGELAND, SC 29728-2304 FAC.#:843-672-5930 FUNDERBURK, FRANCES D PH#: 843-672-5930 Facility Email:

[email protected]

CRC-0999 / 04/30/2013 (Renewal Pending) Alzheimer Unit: Yes Max # Beds: 25 106

Alzheimer Care:Yes

Max # Resident:8

Certifications:None PALMETTO RIDGE ASSISTED LIVING & MEMORY CARE 840 MANOR RD CHERAW, SC 29520-4035 FAC.#:843-537-4197 SMITH, REGINA PH#: 843-537-4197 Facility Email:

[email protected]

Chesterfield / Limited Liability PO BOX 278 CHERAW, SC 29520-0278

PALMETTO RIDGE ASSISTED LIVING AND MEMORY CARE LLC

CRC-1393 / 03/31/2014 Alzheimer Unit: Yes Max # Beds: 26 32

Alzheimer Care:Yes

Max # Resident:15

Certifications:None SPRINGHILL ASSISTED LIVING RETIREMENT COMMUNITY 514 S GUM ST PAGELAND, SC 29728-9143 FAC.#:843-675-2500 ROBERTSON SR, ROBBIE L PH#: 843-675-2500 Facility Email:

Not on File

Chesterfield / Corporation 514 S GUM ST PAGELAND, SC 29728-9143

SPRINGHILL ASSISTED LIVING RETIREMENT COMMUNITY INC

CRC-1171 / 07/31/2013 Alzheimer Unit: No Max # Beds: 0

Alzheimer Care:Yes Certifications:None

Max # Resident:3

Totals For Facility/License Type: Community Residential Care Facility Number of Activities/Facilities licensed: 5 Number Licensed Units: 212

2

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May 1, 2013

South Carolina Department of Health & Environmental Control Division of Health Licensing

County: Chesterfield Facility Type: Home Health

County/Ownership Type Mailing/Billing Address Licensee License Nbr/Expiration Date Chesterfield / Corporation PO BOX 813 CHERAW, SC 29520-0813

CHESTERFIELD VISITING NURSES SERVICE INC

Facility Name Location Street Location City, State Administrator/Phone CHESTERFIELD VISITING NURSES SERVICE 918 CHESTERFIELD HWY CHERAW, SC 29520-7008 FAC.#:843-537-3020 OLIVER, JULIA PH#: 843-537-3020

Licensed Units

3

HHA-0065 / 08/31/2013 Facility Email: Not on File Counties Served: Chesterfield, Darlington, Marlboro License Restrictions: Physical Therapy: N Speech Therapy: N Occupational Therapy:N Med. Social Services: N Home Health Aid: Y Medical Supplies/Appliances/Durable Medical Equipment N Other: Totals For Facility/License Type: Home Health Number of Activities/Facilities licensed: 1 Number Licensed Units: 3

3

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May 1, 2013

South Carolina Department of Health & Environmental Control Division of Health Licensing

County: Chesterfield Facility Type: Hospice Program

County/Ownership Type Mailing/Billing Address Licensee License Nbr/Expiration Date Chesterfield / Non-Profit Corporation PO BOX 293 CHESTERFIELD, SC 29709-0293

HOSPICE OF CHESTERFIELD COUNTY INC

Facility Name Location Street Location City, State Administrator/Phone HOSPICE OF CHESTERFIELD COUNTY 700 WEST BLVD CHESTERFIELD, SC 29709-1406 FAC.#:843-623-9155 DOUGLAS, JOHN H PH#: 843-623-9155 Facility Email: [email protected] Counties Served: Chesterfield, Lancaster, Marlboro

Licensed Units

3

HPC-0026 / 04/30/2014

Totals For Facility/License Type: Hospice Program Number of Activities/Facilities licensed: 1 Number Licensed Units: 3

4

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May 1, 2013

South Carolina Department of Health & Environmental Control Division of Health Licensing

County: Chesterfield Facility Type: Hospital or Institutional General Infirmary

County/Ownership Type Mailing/Billing Address Licensee License Nbr/Expiration Date Chesterfield / Limited Liability Limited Partnership 711 CHESTERFIELD HWY CHERAW, SC 29520-7002

CHESTERFIELD/MARLBORO LP

Facility Name Location Street Location City, State Administrator/Phone CHESTERFIELD GENERAL HOSPITAL 711 CHESTERFIELD HWY CHERAW, SC 29520-7002 FAC.#:843-537-7881 REECE, JERON PH#: 843-537-7881 Facility Email: [email protected] Licensed Beds: General: 59 0 Other Beds : NICU: Psychiatric:

Licensed Units

59

HTL-0681 / 03/31/2014 0 Rehab: 0 Substance Abuse: 0

0

Neonatal Special Care:

Certifications:Swing Bed Unit(s), Perinatal Level I, JCAHO Accredited Totals For Facility/License Type: Hospital or Institutional General Infirmary Number of Activities/Facilities licensed: 1 Number Licensed Units: 59

5

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May 1, 2013

South Carolina Department of Health & Environmental Control Division of Health Licensing

County: Chesterfield Facility Type: Nursing Home

County/Ownership Type Mailing/Billing Address Licensee License Nbr/Expiration Date Chesterfield / Corporation PO BOX 967 CHERAW, SC 29520-0967

CHERAW HEALTHCARE INC

Facility Name Location Street Location City, State Administrator/Phone CHERAW HEALTHCARE 400 MOFFAT DR CHERAW, SC 29520-3048 FAC.#:843-537-5253 DYSON, JOEL W PH#: 843-537-5253 Facility Email:

[email protected]

Licensed Units

120

NCF-0951 / 04/30/2013 (Renewal Pending) Institutional Nursing Home: Alzheimer Unit: No 0 Max # Beds: 0 104

Licensed Beds: Nursing Home: Alzheimer Care:Yes

120

Max # Resident:0

Certifications:None CHESTERFIELD CONVALESCENT CENTER 1150 STATE RD CHERAW, SC 29520-2048 FAC.#:843-537-2060 VILLAFRANCA, GRACE PH#: Facility Email:

[email protected]

Chesterfield / Corporation PO BOX 1329 CHERAW, SC 29520-1329

CHESTERFIELD CONVALESCENT CENTER INC

NCF-0552 / 03/31/2014 Institutional Nursing Home: Alzheimer Unit: No 0 Max # Beds: 0

Licensed Beds: Nursing Home: Alzheimer Care:No Certifications:None

104

Max # Resident:0

Totals For Facility/License Type: Nursing Home Number of Activities/Facilities licensed: 2 Number Licensed Units: 224

6

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May 1, 2013

South Carolina Department of Health & Environmental Control Division of Health Licensing

County: Chesterfield Facility Type: PSAD Outpatient

County/Ownership Type Mailing/Billing Address Licensee License Nbr/Expiration Date Chesterfield / Corporation PO BOX 347 CHESTERFIELD, SC

GIVEBAC INC

Facility Name Location Street Location City, State Administrator/Phone ACE CAMP 1477 TED MELTON RD CHESTERFIELD, SC 29709-6313 FAC.#:843-623-3077 MCLAIN, JEFFREY PH#: 843-623-3077 Facility Email:

[email protected]

Licensed Units

1

29709-0347

OTP-0002 / 05/31/2013

Certifications:None FOURTH JUDICIAL CIRCUIT TREATMENT COURTS PROGRAM 137 MAIN ST CHESTERFIELD, SC 29709-1702 FAC.#:843-623-5460 THURMAN, ANGIE PH#: 843-623-5460 Facility Email:

[email protected]

Chesterfield / State PO BOX 594 CHESTERFIELD, SC 29709-0594

2

FOURTH JUDICIAL CIRCUIT SOLICITOR'S OFFICE

OTP-0093 / 04/30/2013 (Renewal Pending)

Certifications:None Totals For Facility/License Type: PSAD Outpatient Number of Activities/Facilities licensed: 2 Number Licensed Units: 3

7

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May 1, 2013

South Carolina Department of Health & Environmental Control Division of Health Licensing

County: Chesterfield Facility Type: Renal Dialysis

County/Ownership Type Mailing/Billing Address Licensee License Nbr/Expiration Date Chesterfield / Corporation 104 GRACE LN CHERAW, SC 29520-7132

BIO-MEDICAL APPLICATIONS OF SOUTH CAROLINA INC

Facility Name Location Street Location City, State Administrator/Phone FRESENIUS MEDICAL CARE CHERAW 104 GRACE LN CHERAW, SC 29520-7132 FAC.#:843-537-6801 ELLIS, PAMELA DENISE PH#: 000-000-0000 Facility Email:

[email protected]

Licensed Units

21

ERD-0176 / 09/30/2013 21 Peritoneal: 0 Chesterfield / Corporation 16 5200 VIRGINIA WAY STE 400, DAVITA-LICENSURE & CERTIFICATION BRENTWOOD, TN 37027-7569

DVA RENAL HEALTHCARE INC

Licensed Stations: PAGELAND DIALYSIS 505 S PEARL ST STE A

Hemodialysis:

PAGELAND, SC 29728-2222 FAC.#:843-672-3491 DEESE RN, SUNNI M PH#: 803-283-6336 Facility Email:

Not on File

ERD-0160 / 10/31/2013 16 Peritoneal: 0

Licensed Stations:

Hemodialysis:

Totals For Facility/License Type: Renal Dialysis Number of Activities/Facilities licensed: 2 Number Licensed Units: 37

Number of Activities/Facilities licensed in county of :

Chesterfield Number Licensed Units :

# Lics: 601

15

Report Totals Total Number of Activities/Facilities licensed 15 Total Number Licensed Units: 601

8

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