Tishomingo Community Care Center LLC
Organization Active NPI Skilled Nursing Facility · Iuka, MS
NPI 1194773515 · NPPES record last updated Apr 30, 2013
Key facts
- NPI
- 1194773515
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 414 (MS)
- Legal business name
- TISHOMINGO COMMUNITY CARE CENTER LLC
- Practice address
- 230 Kaki Ave
Iuka, MS 38852-1192 - Phone
- (662) 423-9112
- Fax
- (662) 423-9121
- NPI assigned
- May 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Toni Parkinson
- Title
- Authorized Representative
- Phone
- (601) 709-1408
Owners & managing parties with NPI records 1
-
Margaret M Glynn, M.D.
Facilities with the same owner 54
Practitioners 5
-
Margaret M Glynn, M.D.
Affiliated clinicians 6
-
Margaret M Glynn, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Tishomingo Manor
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★☆☆☆☆ 1 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jan 1, 1996
- Medicare certification status
- Active
- Certified beds
- 105 · 99.7 residents per day on average
- Chain
- The Beebe Family
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 2 · fines totaling $29,145
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D0885515 | Tishomingo Manor | Certificate of waiver | Apr 21, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Skilled nursing facility certification: CCN 255218
- Legal name
- TISHOMINGO COMMUNITY CARE CENTER, LLC
- Doing business as
- TISHOMINGO MANOR
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1996
- Last certification
- Apr 2, 2025
- Beds
- 105
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Proprietary
- Enrollment address
- 230 Kaki Street
Iuka, MS 38852-1115 - Nursing home name
- TISHOMINGO MANOR
- Affiliated entity
- THE BEEBE FAMILY
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Elton G. Beebe Sr Irrv Childrens TR |
5% Or Greater Direct Ownership Interest | Jan 1, 2010 | 85% |
| Operational/Managerial Control | Jan 1, 2010 | ||
| Elton G Beebe Sr Irrv Grndchildrens TR |
5% Or Greater Direct Ownership Interest | Jan 1, 2010 | 15% |
| Jennifer Cain |
Operational/Managerial Control | Jun 23, 2011 | |
| Account Management Services Inc |
Operational/Managerial Control | Jan 1, 2010 | |
| Adp of the SNF | Jan 1, 2010 | ||
| Four Generations Holdings LLC |
Adp of the SNF | Jan 1, 2025 | |
| Linda Maynor |
Adp of the SNF | Jan 1, 2011 | |
| Regional Services, Inc |
Operational/Managerial Control | Jan 1, 2023 | |
| Adp of the SNF | Jan 1, 2023 | ||
| Toni H Parkinson |
Corporate Officer |
Nov 15, 2015 | |
| Operational/Managerial Control | Jan 1, 2010 | ||
| Adp of the SNF | Jan 1, 2010 | ||
| Provider Professional Services Inc |
Operational/Managerial Control | Jan 1, 2010 | |
| Adp of the SNF | Jan 1, 2010 | ||
| Tishomingo Properties LLC |
Adp of the SNF | Dec 4, 2025 | |
| Nutrition Systems Consulting Inc |
Adp of the SNF | Jan 31, 2008 | |
| Administrative Systems Inc |
Operational/Managerial Control | Jan 1, 2010 | |
| Adp of the SNF | Jan 1, 2010 | ||
| David W Stallard |
Operational/Managerial Control | Jan 1, 2010 | |
| Adp of the SNF | Jan 1, 2010 | ||
| Margaret M Glynn |
Operational/Managerial Control | Oct 24, 2013 | |
| Adp of the SNF | Oct 24, 2013 | ||
| Bobby L Beebe |
Operational/Managerial Control | Jan 1, 2023 | |
| Adp of the SNF | Jan 1, 2023 | ||
| Providence Care LLC |
Operational/Managerial Control | Jan 1, 2010 | |
| Adp of the SNF | Jan 1, 2010 | ||
| Tristar Rehab Inc |
Operational/Managerial Control | Jan 1, 2024 | |
| Adp of the SNF | Jan 1, 2024 | ||
| Tina Stevens |
Operational/Managerial Control | Oct 16, 2014 | |
| Adp of the SNF | Oct 16, 2014 | ||
| Elton G Beebe Family Mortage Trust |
Adp of the SNF | Jan 1, 2025 | |
| Pharmaceutical Consulting Services of America LLC |
Adp of the SNF | Mar 28, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080118000243 | MS | Part a Provider - Skilled Nursing Facility | 4082795703 | Practice locations: Iuka, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 414 | MS | Yes |
Addresses
Primary practice location
230 Kaki Ave
Iuka, MS 38852-1192
Mailing address
230 Kaki Ave
Iuka, MS 38852-1192
Phone (662) 423-9112
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00230109 | Medicaid | MS | |
| 80488 | Other | MS | BLUE CROSS BLUE SHIELD |
Other names
- Tishomingo Manor
Other providers in Iuka, MS
- Jeannie Swann
- Kylee Tapp
- Sheila Taylor
- Tanechi Temple
- Pamela Thompson
- Tishomingo Health Services, Inc.
- Tishomingo Health Services, Inc.
- Tishomingo Health Services, Inc.
- Tishomingo Health Services, Inc.
- Tishomingo Health Services, Inc.
All providers in Iuka, 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 Apr 30, 2013. 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.