Allegiance Specialty Hospital of Greenville, LLC
Organization Active NPI Long Term Care Hospital · Greenville, MS
NPI 1154560290 · NPPES record last updated Sep 18, 2024
Key facts
- NPI
- 1154560290
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Hospital 282E00000X
- Legal business name
- ALLEGIANCE SPECIALTY HOSPITAL OF GREENVILLE, LLC
- Practice address
- 300 Washington Ave
Greenville, MS 38701-3614 - Phone
- (318) 226-8202
- Fax
- (318) 226-8205
- NPI assigned
- Feb 12, 2009
- Organization subpart
- No
Authorized official
- Name
- Rock Bordelon
- Title
- Owner/Director
- Phone
- (318) 226-8202
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Subparts reporting this organization as parent 1
Facilities with the same owner 48
Affiliated clinicians 4
-
Parvez Karim, M.D.
-
Jared Kerome Taylor, M.D.
-
Mohammad Khursheed Anwar, M.D.
Medicare Care Compare: Hospital
- Listed as
- Allegiance Specialty Hospital of Greenville
- Type
- Long-term
- Ownership
- Proprietary
- Medicare certification status
- Active
- Emergency services
- No
Medicare Care Compare: Long-term care hospital
- Listed as
- Allegiance Specialty Hospital of Greenville
- Ownership
- For profit
- Certified
- Nov 1, 2011
- Medicare certification status
- Active
- Beds
- 39
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Hospital certification: CCN 252013
- Legal name
- ALLEGIANCE SPECIALTY HOSPITAL OF GREENVILLE LLC
- Certification status
- Active
- Provider type (POS)
- Hospital – Long-term
- Participating since
- Nov 1, 2011
- Last certification
- Feb 20, 2025
- Beds
- 69
- Ownership / control type
- Private (for profit)
- Organization structure
- LLC · Proprietary
- Incorporated
- Jan 1, 2006 in LA
- Enrollment address
- 300 South Washington Avenue, 3Rd Floor
Greenville, MS 38701-4719 - Hospital subgroups
- Long-term
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| James Ballengee |
5% Or Greater Indirect Ownership Interest | Apr 26, 2011 | 36% |
| Pamela Reed Redd |
W-2 Managing Employee |
Sep 15, 2025 | |
| Donald Cameron |
Corporate Director | Apr 26, 2011 | |
| Rock Bordelon |
5% Or Greater Direct Ownership Interest |
Apr 26, 2011 | 60% |
| Corporate Director |
Apr 26, 2011 | ||
| Operational/Managerial Control | Apr 26, 2011 | ||
| Allegiance Health Management Inc |
Operational/Managerial Control | Jul 1, 2020 | |
| Mary Helen Ballengee Trust |
5% Or Greater Indirect Ownership Interest | Dec 29, 2017 | 35.64% |
| Scott Markstrom |
Corporate Director |
Apr 26, 2011 | |
| Jorgan Development, LLC |
5% Or Greater Indirect Ownership Interest | Apr 26, 2011 | 36% |
| Timothy Jason Reed |
Corporate Director |
Nov 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120125000436 | MS | Part a Provider - Hospital | 7214129147 |
1 other NPI on this enrollment Practice locations: Cleveland, MS; Greenville, MS |
National Provider Directory
Locations
3800 Viking Dr
Bossier City, LA 71111
Phone (318) 226-8202
300 S Washington Ave
Fl 3
Greenville, MS 38701
Phone (662) 332-7344
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Hospital | 282E00000X | Yes |
Addresses
Primary practice location
300 Washington Ave
Greenville, MS 38701-3614
Mailing address
300 S Washington Ave FL 3
Greenville, MS 38701-4719
Phone (662) 332-7344
Other providers in Greenville, MS
- Javeria Waseem Ahmed
- Air Evac EMS Inc.
- Anissa Quansha Alexander
- Alexander'S Transportation
- Alexandra L Engel, DMD, Ms, PC
- Allegiance Specialty Hospital of Greenville, LLC
- Melody W Allen
- Alliance Oncology LLC
- American Legacy Properties LLC
- An Medi-Zen, PLLC
All providers in Greenville, MS · Long Term Care Hospital in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2024. 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.