Myrtle Beach Manor
9547 Highway 17, North, Myrtle Beach, SC 29572


Myrtle Beach Manor is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 425070. The address is 9547 Highway 17, North, Myrtle Beach, SC 29572. The zip code is 29572. The phone number is 8434495283.


Myrtle Beach Manor · 9547 Highway 17, North, Myrtle Beach, SC 29572

Federal Provider Number 425070
Provider Name MYRTLE BEACH MANOR
Address 9547 HIGHWAY 17, NORTH
MYRTLE BEACH, SC 29572
Phone Number 8434495283
SSA County Code 250
County Name Horry
Ownership Type For profit - Corporation
Certified Beds 60
Certified Beds Residents 51
Provider Type Medicare
Resides in Hospital false
Legal Business Name FS TENANT POOL I TRUST
Date First Approved to Provide Medicare Medicaid Services 07/09/1970
Continuing Care Retirement Community true
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 3
Health Inspection Rating 3
Quality Measure Rating 3
Staffing Rating 3
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.23529
Reported LPN Staffing Hours per Resident per Day 1.34902
Reported RN Staffing Hours per Resident per Day 0.72549
Reported Licensed Staffing Hours per Resident per Day 2.07451
Reported Total Nurse Staffing Hours per Resident per Day 4.3098
Reported Physical Therapist Staffing Hours per Resident Per Day 0.37843
Expected CNA Staffing Hours per Resident per Day 2.5142
Expected LPN Staffing Hours per Resident per Day 0.6405
Expected RN Staffing Hours per Resident per Day 1.16004
Expected Total Nurse Staffing Hours per Resident per Day 4.31474
Adjusted CNA Staffing Hours per Resident per Day 2.1815
Adjusted LPN Staffing Hours per Resident per Day 1.74815
Adjusted RN Staffing Hours per Resident per Day 0.4673
Adjusted Total Nurse Staffing Hours per Resident per Day 4.02628
Cycle 1 Standard Survey Health Date 09/16/2016
Cycle 2 Total Number of Health Deficiencies 8
Cycle 2 Number of Standard Health Deficiencies 8
Cycle 2 Number of Complaint Health Deficiencies 8
Cycle 2 Health Deficiency Score 60
Cycle 2 Standard Health Survey Date 05/21/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 60
Cycle 3 Total Number of Health Deficiencies 8
Cycle 3 Number of Standard Health Deficiencies 8
Cycle 3 Health Deficiency Score 40
Cycle 3 Standard Health Survey Date 01/24/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 40
Total Weighted Health Survey Score 26.667
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Myrtle Beach Manor

Owner Name Role Association Date
BEARD, MICHAEL (Individual) MANAGING EMPLOYEE since 12/01/2006
BLACKROCK INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
7%
since 12/31/2015
CLARK, JENNIFER (Individual) OFFICER since 12/01/2006
DIMENSIONAL FUND ADVISORS LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
7%
since 12/31/2015
DOYLE, RICHARD (Individual) OFFICER since 01/01/2016
FIVE STAR QUALITY CARE INC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2006
FS TENANT HOLDING COMPANY TRUST (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2006
FSQ INC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2006
HERZIG, ROBERT (Individual) OFFICER since 11/07/2012
MACKEY, BRUCE (Individual) OFFICER since 05/01/2008
MARTIN, GERARD (Individual) DIRECTOR since 12/01/2006
MARZELLI, ANTHONY (Individual) MANAGING EMPLOYEE since 01/01/2011
OSTERMAN, JENNIFER (Individual) MANAGING EMPLOYEE since 11/21/2013
PORTNOY, BARRY (Individual) DIRECTOR since 12/06/2006
POTTER, KATHERINE (Individual) OFFICER since 02/27/2012
RIGGAN, MISTY (Individual) MANAGING EMPLOYEE since 11/12/2015
SENIOR HOUSING PROPERTIES TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
9%
since 12/31/2015

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