555 John R Junkin Drive Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

555 JOHN R JUNKIN DRIVE OPCO LLC

Practice address

555 John R Junkin Dr
Natchez, MS 39120-4709

Phone

(601) 442-4396

Fax

(601) 442-0321

NPI assigned

Dec 23, 2024

Organization subpart

No

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

Authorized official

Name

Tiffany Hoback

Title

Manager

Phone

(770) 698-9040

Specialties & licenses 1

Addresses

Other names 1

• Grand Trace Health and Rehabilitation Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Skilled nursing facility certification: CCN 255173

Legal name

555 JOHN R JUNKIN DRIVE OPCO LLC

Doing business as

GRAND TRACE HEALTH AND REHABILITATION

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Mar 1, 1994

Last certification

Mar 27, 2025

Beds

96

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Consulate

Organization structure

LLC

Enrollment address

555 John R Junkin Dr
Natchez, MS 39120-4709

Nursing home name

GRAND TRACE HEALTH AND REHABILITATION

Affiliated entity

AVARDIS HEALTH

Listed as

Grand Trace Health and RehabilitationCCN 255173

Overall star rating

1 of 5

Health inspections

1 of 5

Staffing

2 of 5

Quality measures

1 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Mar 1, 1994

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9664.8 residents per day on average

Chain

Avardis Health38 facilities in the chain

Penalties (3 years)

2Fines totaling $33,940

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

All disclosed owners & managing parties 19

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Charles D Borum, M.D.

  • Specialist
  • Natchez, MS
  • NPI 1417042979

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 41

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

• 1001 Hospital Road Opco LLC

  • Skilled Nursing Facility
  • Starkville, MS
  • NPI 1265240113

  SNF MGR LLC

  CMS ownership
• 101 Kirkland Street Opco LLC

  • Skilled Nursing Facility
  • Union, MS
  • NPI 1851109896

  SNF MGR LLC

  CMS ownership
• 1199 Ocean Springs Road Operations, LLC

  • Skilled Nursing Facility
  • Ocean Springs, MS
  • NPI 1326795923

  SNF MGR LLC

  CMS ownership
• 1304 Walnut Street Operations, LLC

  • Skilled Nursing Facility
  • Waynesboro, MS
  • NPI 1598412199

  SNF MGR LLC

  CMS ownership
• 1530 Broad Avenue Operations, LLC

  • Skilled Nursing Facility
  • Gulfport, MS
  • NPI 1306593900

  SNF MGR LLC

  CMS ownership
• 340 Desoto Avenue Ext Operations, LLC

  • Skilled Nursing Facility
  • Clarksdale, MS
  • NPI 1932856531

  SNF MGR LLC

  CMS ownership
• 3716 Highway 39 North Opco LLC

  • Skilled Nursing Facility
  • Meridian, MS
  • NPI 1306654355

  SNF MGR LLC

  CMS ownership
• 501 South Locust Street Opco LLC

  • Skilled Nursing Facility
  • McComb, MS
  • NPI 1437967536

  SNF MGR LLC

  CMS ownership
• 538 Menge Avenue Operations, LLC

  • Skilled Nursing Facility
  • Pass Christian, MS
  • NPI 1124776232

  SNF MGR LLC

  CMS ownership
• 627 Middleton Road Opco LLC

  • Skilled Nursing Facility
  • Winona, MS
  • NPI 1285442137

  SNF MGR LLC

  CMS ownership
• 1000 Stacie Drive Opco LLC

  • Skilled Nursing Facility
  • Hazleton, PA
  • NPI 1174331029

  SNF MGR LLC

  CMS ownership
• 1000 Tandall Place Opco LLC

  • Skilled Nursing Facility
  • Knightdale, NC
  • NPI 1790593648

  SNF MGR LLC

  CMS ownership

Practitioners 1

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

• Charles D Borum, M.D.

  • Specialist
  • Natchez, MS
  • NPI 1417042979
  NPD (past)

Affiliated clinicians 1

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

• Charles D Borum, M.D.

  • Specialist
  • Natchez, MS
  • NPI 1417042979

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1734912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741564800000",
    "number": "1215745252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 JOHN R JUNKIN DR",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391204709",
            "telephone_number": "601-442-4396",
            "fax_number": "601-442-0321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 JOHN R JUNKIN DR",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391204709",
            "telephone_number": "601-442-4396",
            "fax_number": "601-442-0321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "555 JOHN R JUNKIN DRIVE OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-23",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A",
        "authorized_official_last_name": "HOBACK",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-698-9040"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.5042",
            "affiliationName": "Synergy Healthcare Services",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "850 Concourse Pkwy S Ste 250",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Grand Trace Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Natchez, MS
• Providers in Natchez, MS by specialty
• Skilled Nursing Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (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.