NPIMap

Organization Active NPI

Mississippi Commcare Corporation a Non Profit Corporation

  • Skilled Nursing Facility
  • Jackson, MS
National Provider Identifier
1083788053
Registry record updated Jul 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
385 Issued in MS
Legal business name
MISSISSIPPI COMMCARE CORPORATION A NON PROFIT CORPORATION
Practice address
3680 Lakeland LN
Jackson, MS 39216-4707
Phone
(601) 982-5505
Fax
(601) 362-1883
NPI assigned
Nov 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2026

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

Authorized official

Name
Dawn Harvey Psarellis
Title
Vice President
Phone
(504) 324-8950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 385 MS Primary

Addresses

Primary practice location

3680 Lakeland LN
Jackson, MS 39216-4707

Mailing address

950 W Causeway Approach
Mandeville, LA 70471-3082
Phone (504) 324-8950

Other identifiers 3

IdentifierTypeStateIssuer
000071705MedicaidMS
000080392OtherMSBC BS OF MISSISSIPPI
00071705MedicaidMS

Other names 1

  • Lakeland Community Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030624000034 MS Part A Provider - Skilled Nursing Facility 8325958366 Practice locations: Jackson, MS

Skilled nursing facility certification: CCN 255116

Legal name
LAKELAND NURSING AND REHABILITATION CENTER, LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 1, 1989
Last certification
Jan 30, 2025
Beds
105
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
May 6, 2003 in MS
Enrollment address
3680 Lakeland LN
Jackson, MS 39216-4707

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lakeland Community Care CenterCCN 255116
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10593.8 residents per day on average
Penalties (3 years)
1Fines totaling $8,424

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0674816Lakeland Nursing and Rehabilitation Center3680 Lakeland Lane, Jackson, MS 39216Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

3680 Lakeland Ln
Jackson, MS 39216
Phone (601) 376-2561

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Donad T Denz Irrv TR Organization, Buffalo, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 6%
Norbert a Bennett Individual 5% Or Greater Indirect Ownership Interest Jun 30, 2003 32.45%
Sheila Cooper Individual W-2 Managing EmployeeDirector of Nursing Aug 3, 2016 100%
Donald T Denz Individual 5% Or Greater Indirect Ownership Interest Jun 30, 2003 44%
Norbert a Bennett Irrv TR Fbo Grandchildren Organization, Holland, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 17.55%
Norbert a Bennett Irrv TR Fbo Children Organization, Holland, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 17.55%
Renee Klawon Individual OtherIndependent Contractor Aug 14, 2020
D&N, LLC Organization, Orchard Park, NY Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Jun 30, 2003 50%
DTD HC LLC Organization, Orchard Park, NY Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Jun 30, 2003 50%
Abby Little Individual W-2 Managing EmployeeExecutive Director Jun 30, 2003 100%

Facilities with the same owner 30

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

View all 30

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784073600000",
    "number": "1083788053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 W CAUSEWAY APPROACH",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704713082",
            "telephone_number": "504-324-8950",
            "fax_number": "985-624-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3680 LAKELAND LN",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164707",
            "telephone_number": "601-982-5505",
            "fax_number": "601-362-1883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI COMMCARE CORPORATION A NON PROFIT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A",
        "authorized_official_last_name": "PSARELLIS",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "HARVEY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "504-324-8950"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000071705",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF MISSISSIPPI",
            "identifier": "000080392",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00071705",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeland Community Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.