October 2, 2020 South Carolina Department of Health ...

October 2, 2020

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

County: Laurens

Facility Type: Adult Day Care

Facility Name Location Street Location City, State Administrator/Phone

County/Ownership Type Mailing/Billing Address Licensee License Nbr/Expiration Date

ELITE DAY CENTER OF LAURENS 311 N HARPER ST LAURENS, SC 29360 FAC.#:864-869-8730

PH#: Facility Email: ANA.JUERGES@

Number of Participants: PIEDMONT AGENCY ON AGING 512 PROFESSIONAL PARK RD CLINTON, SC 29325-7627 FAC.#:864-938-0572

PH#: Facility Email: TBEDENBAUGH@

Number of Participants:

Laurens / Limited Liability

ELITE HOMECARE LLC ADC-0445 / 08/31/2021

53 Laurens / Corporation PO BOX 997 GREENWOOD, SC 29648 PIEDMONT AGENCY ON AGING INC ADC-0093 / 02/28/2021

30

Totals For Facility/License Type: Adult Day Care

Number of Activities/Facilities licensed:

2

Number Licensed Units:

Licensed Units 53

30

83

1

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October 2, 2020

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

County: Laurens

Facility Type: Ambulatory Surgery

Facility Name Location Street Location City, State Administrator/Phone

County/Ownership Type Mailing/Billing Address Licensee License Nbr/Expiration Date

Licensed Units

SURGERY AND LASER CENTER AT PROFESSIONAL PARK LLC Laurens / Ltd. Liability

3

136 PROFESSIONAL PARK RD

136 PROFESSIONAL PARK RD

CLINTON, SC 29325-7623 FAC.#:864-938-9836

CLINTON, SC 29325-7623

WILDMAN CAREY A PH#: 864-938-9836 Facility Email: CWILDMAN@

SURGERY AND LASER CENTER AT PROFESSIONAL PARK LLC ASF-0142 / 08/31/2021

Operating Rooms:

2 Procedure Rooms: 1 Endoscopy Rooms: 0

Totals For Facility/License Type: Ambulatory Surgery

Number of Activities/Facilities licensed:

1

Number Licensed Units:

3

2

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October 2, 2020

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

County: Laurens

Facility Type: Body Piercing

Facility Name Location Street Location City, State Administrator/Phone

County/Ownership Type Mailing/Billing Address Licensee License Nbr/Expiration Date

INKWORKS PIERCING 2283 S MAIN ST FOUNTAIN INN, SC 29644-6832 FAC.#:864-862-5552 SIERPUTOWSKI PHILLIP J PH#: 864-304-8533 Facility Email: INKWORKSTATTOO@

Laurens / Sole Proprietorship 2283 S MAIN ST FOUNTAIN INN, SC 29644 SIERPUTOWSKI PHILLIP J BP-0281 / 08/31/2021

Totals For Facility/License Type: Body Piercing

Number of Activities/Facilities licensed:

1

Number Licensed Units:

Licensed Units 1

1

3

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October 2, 2020

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

County: Laurens

Facility Type: CDAP Outpatient

Facility Name Location Street Location City, State Administrator/Phone

County/Ownership Type Mailing/Billing Address Licensee License Nbr/Expiration Date

Licensed Units

CLEAR SKYE TREATMENT CENTER

Laurens /

1

1035 MEDICAL RIDGE RD

CLINTON, SC 29325 FAC.#:864-547-2089

GORDON TRICIA PH#: 864-547-2086

CLEAR SKYE MEDICAL HOLDINGS LLC

Facility Email: DIRECTOR@CLEARSKYETREATMENTCENTERS.CO OPFN-0172 / 09/30/2021

M Certifications:Narcotics Treatment Program, Methodone Treatment Program

GATEWAY COUNSELING CENTER

Laurens / County

1

219 HUMAN SERVICES RD

219 HUMAN SERVICES RD

CLINTON, SC 29325-7548 FAC.#:864-833-6500

CLINTON, SC 29325-7548

STINSON CHARLES PH#: 864-833-6500 Facility Email: CSTINSON@

LAURENS COUNTY COMMISSION ON ALCOHOL AND DRUG ABUSE OPF-0035 / 10/31/2020

Certifications:None

Totals For Facility/License Type: CDAP Outpatient

Number of Activities/Facilities licensed:

2

Number Licensed Units:

2

4

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October 2, 2020

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

County: Laurens

Facility Type: Community Residential Care Facility

Facility Name Location Street Location City, State Administrator/Phone

County/Ownership Type Mailing/Billing Address Licensee License Nbr/Expiration Date

Licensed Units

CAROLINA GARDENS AT LAURENS 420 W FARLEY AVE LAURENS, SC 29360 FAC.#:864-984-9844

PH#: Facility Email: LMIMS@

Alzheimer Care:Yes

Max # Resident:0

Certifications:None DAVIDSON STREET COMMUNITY RESIDENCE 313 DAVIDSON ST CLINTON, SC 29325-2023 FAC.#:864-833-7284 TAVENNER JASON PH#: 864-833-7284 Facility Email: JTAVENNER@

Alzheimer Care:No

Max # Resident:0

Certifications:None LANGSTON PLACE 939 SPRINGDALE DR CLINTON, SC 29325-7266 FAC.#:864-833-0338 MORGAN MARY A PH#: 864-833-0338 Facility Email: MAMORGAN@

Alzheimer Care:No

Max # Resident:0

Certifications:None LAURENS ESTATES 2841 BYPASS 127 LAURENS, SC 29360-8332 FAC.#:864-984-8001 SHIPMAN SUSAN F PH#: 864-984-8001 Facility Email: SSHIPMAN@

Alzheimer Care:No

Max # Resident:0

Certifications:None LAURENS MEMORIAL HOME FOR AGED 3744 TORRINGTON RD LAURENS, SC 29360-0638 FAC.#:864-682-2322 PENLAND CAROLYN B PH#: 864-682-2322 Facility Email: CPENLAND@

Alzheimer Care:Yes

Max # Resident:2

Certifications:None

Laurens / Limited Liability

100

420 W FARLEY AVE

LAURENS, SC 29360

SGS LAURENS OPCO LLC

CRC-2055 / 03/31/2021

Alzheimer Unit: No

Max # Beds: 0

Laurens / Non-Profit Corporation

8

1860 HWY 14

LAURENS, SC 29360-1068

LAURENS COUNTY DISABILITIES AND SPECIAL NEEDS BOARD CRC-1420 / 12/31/2020

Alzheimer Unit: No

Max # Beds: 0

Laurens /

44

330 N WABASH AVE STE 3700

CHICAGO, IL 60611-7605

LANGSTON AID OPCO LLC

CRC-1408 / 11/30/2020

Alzheimer Unit: No

Max # Beds: 0

Laurens /

34

2841 BYPASS 127

LAURENS, SC 29360-8332

LAURENS ESTATES LLC

CRC-0681 / 08/31/2021

Alzheimer Unit: No

Max # Beds: 0

Laurens / Non-Profit Corporation

50

PO BOX 638

LAURENS, SC 29360-0638

LAURENS MEMORIAL HOME FOR AGED INC

CRC-0316 / 12/31/2020

Alzheimer Unit: No

Max # Beds: 0

5

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