Claiborne County Senior Care LLC

Key facts

NPI: 1154513414
Entity type: Organization (NPI type 2)
Primary specialty: Skilled Nursing Facility 314000000X
License: 679 (MS)
Legal business name: CLAIBORNE COUNTY SENIOR CARE LLC
Practice address: 2124 Old Highway 61 S
Port Gibson, MS 39150-2589
Phone: (601) 437-8737
Fax: (601) 437-8724
NPI assigned: Aug 10, 2007
Organization subpart: No

Authorized official

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

Practitioners 1

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

David McCaa Headley, MD Family Medicine Physician · Port Gibson, MS · NPI 1528032406

NPD (past)

Affiliated clinicians 1

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

David McCaa Headley, MD Family Medicine Physician · Port Gibson, MS · NPI 1528032406

Care Compare affiliation Nursing home

Medicare Care Compare: Nursing home

Listed as: Claiborne County Senior Care CCN 255192
Overall star rating: ★★★★★ 5 of 5
Health inspections: ★★★★☆ 4 of 5
Staffing: ★★★★★ 5 of 5
Quality measures: ★★☆☆☆ 2 of 5
Type: Medicare and Medicaid
Ownership: For profit - Corporation
Certified: Dec 1, 1994
Medicare certification status: Active (Provider of Services file)
Certified beds: 65 · 56.0 residents per day on average
Chain: Trend Consultants (15 facilities)

Source: Medicare Care Compare, processed Aug 1, 2026.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
25D0862211	Claiborne County Senior Care 2124 Old Hwy 61 S, Port Gibson, MS 39150	Certificate of waiver	Aug 31, 2026

Medicare participation

Medicare fee-for-service enrollment: Enrolled in MS

Skilled nursing facility certification: CCN 255192

Legal name: CLAIBORNE COUNTY SENIOR CARE LLC
Certification status: Active
Provider type (POS): Nursing home – SNF/NF dual certification
Participating since: Dec 1, 1994
Last certification: Feb 29, 2024
Beds: 65
Ownership / control type: Corporation
Organization structure: LLC · Proprietary
Incorporated: Aug 1, 2007 in MS
Enrollment address: 2124 Old Highway 61 S
Port Gibson, MS 39150-2589
Nursing home name: CLAIBORNE COUNTY SENIOR CARE
Affiliated entity: TREND CONSULTANTS

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.

Name	Role	Since
Lori Warnock Individual	Operational/Managerial Control	Jan 24, 2024
Lori Warnock Individual	Adp of the SNF	Jan 24, 2021
Individual	Adp of the SNF	Dec 11, 2024
Claiborne County Senior Care LLC Organization · Port Gibson, MS Corporation	Operational/Managerial Control	Nov 1, 2012
Charles B Kelly Individual	5% Or Greater Direct Ownership Interest	Aug 1, 2007
Charles B Kelly Individual	Adp of the SNF	Aug 1, 2000
Individual	Adp of the SNF	Nov 1, 2012

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20070827000214	MS	Part a Provider - Skilled Nursing Facility	3870685563	Practice locations: Port Gibson, MS

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Skilled Nursing Facility	314000000X	679	MS	Yes

Addresses

Primary practice location

2124 Old Highway 61 S
Port Gibson, MS 39150-2589

Mailing address

2124 Old Highway 61 S
P O Box 1018
Port Gibson, MS 39150-2589
Phone (601) 437-8737

Other providers in Port Gibson, MS

All providers in Port Gibson, 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 Aug 10, 2007. 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.

Verify at the official NPI Registry.