NPIMap

Organization Active NPI

Billdora Senior Care LLC

  • Skilled Nursing Facility
  • Tylertown, MS
National Provider Identifier
1013109479
Registry record updated Aug 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
179 Issued in MS
Legal business name
BILLDORA SENIOR CARE LLC
Practice address
314 Enochs St
Tylertown, MS 39667-2716
Phone
(601) 876-2173
Fax
(601) 876-4904
NPI assigned
Aug 9, 2007
Last updated
Aug 9, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2007

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

Authorized official

Name
Mrs. Tina Ellis
Title
Comptroller
Phone
(601) 304-0980

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 179 MS Primary

Addresses

Primary practice location

314 Enochs St
Tylertown, MS 39667-2716

Mailing address

314 Enochs St
Tylertown, MS 39667-2716
Phone (601) 876-2173

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070827000166 MS Part A Provider - Skilled Nursing Facility 3274625959 Practice locations: Tylertown, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013109479. Details of each certification follow.

Skilled nursing facility certification: CCN 255243

Legal name
BILLDORA SENIOR CARE LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 1, 1997
Last certification
Mar 6, 2025
Beds
60
Ownership / control type
Corporation
Multi-facility organization
Cognos
Organization structure
LLCProprietary
Incorporated
Aug 1, 2007 in MS
Enrollment address
314 Enochs St
Tylertown, MS 39667-2716
Nursing home name
BILLDORA SENIOR CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Billdora Senior CareCCN 255243 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Feb 1, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6043.9 residents per day on average
Penalties (3 years)
2Fines totaling $14,020

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Stephanie S Burton Individual Adp of the SNF Jul 14, 2025
Andrew T Montgomery Individual Operational/Managerial Control Mar 1, 2022
Adp of the SNF Mar 1, 2022
Tillman Senior Care, LLC Organization, Natchez, MS LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2017 100%
Individual Adp of the SNF Jul 14, 2025
Clifford Tillman Individual 5% Or Greater Indirect Ownership InterestMember Jan 1, 2017 99%
Adp of the SNF Aug 1, 2007
Indirect Ownership Interest Jan 1, 2017 99%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186617600000",
    "number": "1013109479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 ENOCHS ST",
            "city": "TYLERTOWN",
            "state": "MS",
            "postal_code": "396672716",
            "telephone_number": "601-876-2173",
            "fax_number": "601-876-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 ENOCHS ST",
            "city": "TYLERTOWN",
            "state": "MS",
            "postal_code": "396672716",
            "telephone_number": "601-876-2173",
            "fax_number": "601-876-4904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BILLDORA SENIOR CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-09",
        "last_updated": "2007-08-09",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "COMPTROLLER",
        "authorized_official_telephone_number": "601-304-0980",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tylertown, MS

Sources for this page

Verify at the official NPI Registry.