CLC of Vaiden, LLC
Organization Active NPI Skilled Nursing Facility · Vaiden, MS
NPI 1144210394 · NPPES record last updated Jan 15, 2008
Key facts
- NPI
- 1144210394
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 947 (MS)
- Legal business name
- CLC OF VAIDEN, LLC
- Practice address
- 868 Mulberry St
Vaiden, MS 39176-5385 - Phone
- (662) 464-7714
- Fax
- (662) 464-7741
- NPI assigned
- Oct 27, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Douglas M. Wright Jr.
- Title
- Managing Member
- Phone
- (662) 680-3148
Facilities with the same owner 16
Practitioners 2
-
Steven Keith Rushing, M.D.
Affiliated clinicians 2
-
Steven Keith Rushing, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Vaiden Community Living Center
- 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 - Limited Liability company
- Certified
- Nov 2, 2001
- Medicare certification status
- Active
- Certified beds
- 60 · 57.7 residents per day on average
- Chain
- Community Eldercare Services
- Penalties (3 years)
- 1 · fines totaling $8,788
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D0992348 | Vaiden Community Living Center | Certificate of waiver | Oct 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Skilled nursing facility certification: CCN 255283
- Legal name
- CLC OF VAIDEN, LLC
- Doing business as
- VAIDEN COMMUNITY LIVING CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 2, 2001
- Last certification
- Oct 17, 2024
- Beds
- 60
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Aug 24, 2001 in MS
- Enrollment address
- 868 Mulberry St
Vaiden, MS 39176-5385 - Nursing home name
- VAIDEN COMMUNITY LIVING CENTER
- Affiliated entity
- COMMUNITY ELDERCARE SERVICES
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Heather Palculict |
Operational/Managerial Control | May 7, 2024 | |
| Adp of the SNF | May 7, 2024 | ||
| Community Living Centers, LLC |
5% Or Greater Direct Ownership Interest | Apr 1, 2000 | 100% |
| Community Eldercare Services, LLC |
Operational/Managerial Control | Apr 1, 2000 | |
| Douglas Wright |
5% Or Greater Indirect Ownership Interest | Aug 24, 2001 | 100% |
| Operational/Managerial Control | Aug 24, 2001 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080212000586 | MS | Part a Provider - Skilled Nursing Facility | 8820171986 | Practice locations: Vaiden, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 947 | MS | Yes |
Addresses
Primary practice location
868 Mulberry St
Vaiden, MS 39176-5385
Mailing address
868 Mulberry St
Vaiden, MS 39176-5385
Phone (662) 464-7714
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0230151 | Medicaid | MS |
Other names
- Vaiden Community Living Center
Other providers in Vaiden, MS
- Caring Hearts Home Care LLC
- Whitney Johnson
- Amber Shannon Joiner
- Anna King
- Mallory Community Health
- Peace Wellness Center LLC
All providers in Vaiden, MS · Skilled Nursing Facility in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2008. 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.