NPIMap

Organization Active NPI

Washington County LTC, Inc.

  • Skilled Nursing Facility
  • Greenville, MS
National Provider Identifier
1245394501
Registry record updated Apr 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
738 Issued in MS
Legal business name
WASHINGTON COUNTY LTC, INC.
Practice address
1221 E Union St
Greenville, MS 38703-3243
Phone
(662) 335-5811
Fax
(662) 332-2551
NPI assigned
Dec 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2013

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

Authorized official

Name
Tessa Cooper
Title
Administrator
Phone
(662) 335-5811

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 738 MS Primary

Addresses

Primary practice location

1221 E Union St
Greenville, MS 38703-3243

Mailing address

1221 E Union St
Greenville, MS 38703-3243
Phone (662) 335-5811

Other identifiers 1

IdentifierTypeStateIssuer
00230075MedicaidMS

Other names 1

  • MS Care Center of Greenville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041027001244 MS Part A Provider - Skilled Nursing Facility 5597727024 Practice locations: Greenville, MS

Skilled nursing facility certification: CCN 255252

Legal name
WASHINGTON COUNTY LTC, INC.
Doing business as
MS CARE CENTER OF GREENVILLE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 1, 1997
Last certification
Feb 5, 2025
Beds
90
Ownership / control type
Corporation
Organization structure
CorporationProprietary
Incorporated
Sep 9, 2004 in MS
Enrollment address
1221 E Union St
Greenville, MS 38703-3243
Nursing home name
MS CARE CENTER OF GREENVILLE
Affiliated entity
MISSISSIPPI CARE CENTER

Care Compare: Nursing home

Medicare Care Compare
Listed as
Ms Care Center of GreenvilleCCN 255252
Overall star rating
4 of 5
Health inspections
5 of 5
Staffing
2 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Nov 1, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9073.9 residents per day on average
Chain
Mississippi Care Center5 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
John L Herzog Individual Adp of the SNF Jan 1, 2024
Rebecca H Shelton Individual Corporate OfficerBoard Member/Officer May 5, 2014
Harold M Beebe Individual Corporate Director Nov 1, 2004
Steven L Delaney Individual 5% Or Greater Direct Ownership Interest Nov 1, 2004 50%
Corporate Director Oct 27, 2004 50%
Garry H Pace Individual 5% Or Greater Direct Ownership Interest Nov 1, 2004 50%
Corporate Director Oct 27, 2004 50%
Adp of the SNF Nov 1, 2004
Samantha M Buford Individual Operational/Managerial Control May 1, 2015
Adp of the SNF Jan 1, 2022

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 2

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

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366934400000",
    "number": "1245394501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 E UNION ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387033243",
            "telephone_number": "662-335-5811",
            "fax_number": "662-332-2551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 E UNION ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387033243",
            "telephone_number": "662-335-5811",
            "fax_number": "662-332-2551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON COUNTY LTC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2013-04-26",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "TESSA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-335-5811"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00230075",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MS Care Center of Greenville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, MS

Sources for this page

Verify at the official NPI Registry.