Hospital Authority of Mitchell County
Organization Active NPI Skilled Nursing Facility · Camilla, GA
NPI 1003903022 · NPPES record last updated Apr 25, 2019
Key facts
- NPI
- 1003903022
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 1-101-125 (GA)
- Legal business name
- HOSPITAL AUTHORITY OF MITCHELL COUNTY
- Practice address
- 37 S Ellis St
Camilla, GA 31730-1812 - Phone
- (229) 336-8377
- NPI assigned
- Oct 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Gregory S. Hembree
- Title
- Cfo
- Phone
- (229) 228-2880
Owners & managing parties with NPI records 14
-
Jason Odell Burnette, M.D.
-
Jason Mark Nesmith, M.D.
-
Stephen A Rubendall Jr., M.D.
-
Brian J Szwarc, M.D.
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 9
Facilities with the same owner 11
Practitioners 25
-
Stephen A Rubendall Jr., M.D.
-
Sarah Brooks, NP
-
Mary Anne Bullard, M.D.
-
John Bennett Carico, M.D.
-
Sharif Darwish, M.D.
-
Jenna Roberts Garrett, NURSE PRACTITIONER
-
Magan S Gilliam, NP
-
Cary Carter Newman, M.D.
-
Gregory Louis Roesel, M.D.
-
Jacqueline Smith, M.D.
-
Michael Loy Cobb, MD
-
Ravi Mulchand Giyanani, M.D.
-
Ronnie M. Gundlach, D.O.
-
Michael O'Connor Harding, D.O.
-
Mark Helquist, M.D.
-
Robert Nima Joodi, M.D.
-
Brandi D Lanier, MD
-
Alan G Pratt, MD
-
Anton Shapoval, M.D.
-
Sandra T Willis Curry, M.D.
Affiliated clinicians 2
-
Jason E Griffin, M.D.
-
Stephen A Rubendall Jr., M.D.
Medicare Care Compare: Nursing home
- Listed as
- Archbold Living Camilla
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- Government - County
- Certified
- Jul 1, 1979
- Medicare certification status
- Active
- Certified beds
- 156 · 136.4 residents per day on average
- Special focus status
- SFF Candidate
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 2 · fines totaling $17,345
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2191979 | Mitchell Convalescent Center | Certificate of waiver | Sep 2, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Skilled nursing facility certification: CCN 115266
- Legal name
- HOSPITAL AUTHORITY OF MITCHELL COUNTY
- Doing business as
- MITCHELL COUNTY NURSING HOMES
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 1, 1979
- Last certification
- May 11, 2023
- Beds
- 156
- Ownership / control type
- County
- Multi-facility organization
- John D Archbold Memorial Hospital
- Organization structure
- Other · Non-profit
- Enrollment address
- 37 S Ellis St
Camilla, GA 31730-1812 - Nursing home name
- ARCHBOLD LIVING CAMILLA
All disclosed owners & managing parties 31
| Name | Role | Since | Share |
|---|---|---|---|
| |
Indirect Ownership Interest | Jan 1, 2020 | |
| Andrea Kidd Collins |
Corporate Officer |
Feb 25, 2025 | |
| James Womack |
Corporate Officer |
Dec 19, 2020 | |
| Adp of the SNF | Dec 1, 2023 | ||
| Craig R Wentworth |
Corporate Director |
Oct 1, 2021 | |
| Patricia L Barrett |
Operational/Managerial Control | Dec 16, 1991 | |
| Carla Pearce |
Corporate Officer |
Oct 1, 2021 | |
| Brian J Szwarc |
Corporate Director |
Oct 1, 2021 | |
| |
Adp of the SNF | Apr 7, 2025 | |
| Sina E. Griffith |
Corporate Director |
Oct 1, 2021 | |
| Jason Odell Burnette |
Corporate Officer |
Mar 1, 2025 | |
| |
Adp of the SNF | Apr 10, 2025 | |
| Josh David Simmons |
Corporate Director |
Jan 1, 2023 | |
| |
Adp of the SNF | Apr 11, 2025 | |
| John D Archbold Memorial Hospital Inc |
Operational/Managerial Control | Oct 1, 1990 | |
| Adp of the SNF | Oct 1, 1990 | ||
| Henry a. Stone |
Corporate Director |
Oct 1, 2021 | |
| Timothy Eric Ward |
Corporate Officer |
Feb 25, 2025 | |
| Karen L Bramblett |
Corporate Director |
Jan 1, 2023 | |
| Darcy M Craven |
Corporate Director |
Oct 1, 2021 | |
| Joe S Carnline |
Corporate Director |
Jan 1, 2023 | |
| Ashley T. Cason |
Corporate Director |
Jan 1, 2023 | |
| Libby M. Gardner |
Corporate Officer |
Jul 5, 2022 | |
| Adp of the SNF | Jul 5, 2022 | ||
| Christopher L Daniels |
Corporate Officer |
Mar 1, 2025 | |
| Stephen a Rubendall |
Adp of the SNF | Apr 10, 2025 | |
| Indirect Ownership Interest | Oct 1, 2009 | ||
| Marvin E. Dawson |
Corporate Director |
Jan 1, 2023 | |
| |
Adp of the SNF | Apr 11, 2025 | |
| William G Hamil |
Corporate Director |
Jan 28, 2023 | |
| Jami Porter |
Corporate Director |
Jan 1, 2023 | |
| |
Adp of the SNF | Oct 1, 2020 | |
| Gregory Hembree |
Corporate Officer |
Dec 5, 2016 | |
| Jacquelyn V. Santoro |
Corporate Director |
Jan 1, 2023 | |
| Jason M Nesmith |
Corporate Director |
Oct 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080310000658 | GA | Part a Provider - Skilled Nursing Facility | 6002724598 |
2 other NPIs on this enrollment Practice locations: Camilla, GA; Pelham, GA |
National Provider Directory
- Tax ID family
- Mitchell County Hosp PH
Locations
37 S Ellis St
Camilla, GA 31730
Phone (229) 336-8377
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 1-101-125 | GA | Yes |
Addresses
Primary practice location
37 S Ellis St
Camilla, GA 31730-1812
Mailing address
920 Cairo Rd
Thomasville, GA 31792-4255
Phone (229) 228-8800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000142018A | Medicaid | GA |
Other names
- Mitchell Convalescent Center
Other providers in Camilla, GA
- Davon Hicks
- Randall Leonard Hines Sr.
- Courtney L Hipps
- Janie Holton
- Hope Behavioral Health & Addictive Disease Wellness Center
- Hospital Authority of Mitchell County
- Hospital Authority of Mitchell County
- Hospital Authority of Mitchell County
- Hospital Authority of Mitchell County
- Hospital Authority of Mitchell County
All providers in Camilla, GA · Skilled Nursing Facility in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2019. 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.