NPIMap

Organization Active NPI

Mississippi Commcare Corporation a Non Profit Corporation

Doing business as Ruleville Community Care Center

  • Skilled Nursing Facility
  • Ruleville, MS
National Provider Identifier
1255405205
Registry record updated Jul 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
913 Issued in MS
Legal business name
MISSISSIPPI COMMCARE CORPORATION A NON PROFIT CORPORATION
Doing business as
Ruleville Community Care Center
Practice address
800 Stansel Dr
Ruleville, MS 38771-3320
Phone
(662) 756-4361
Fax
(662) 756-2788
NPI assigned
Nov 20, 2006
Last updated
Jul 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2026

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

Authorized official

Name
Dawn Harvey Psarellis
Title
Vice President
Phone
(504) 324-8950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 913 MS Primary

Addresses

Primary practice location

800 Stansel Dr
Ruleville, MS 38771-3320

Mailing address

950 W Causeway Approach
Mandeville, LA 70471-3082
Phone (504) 324-8950

Other identifiers 3

IdentifierTypeStateIssuer
007031277MedicaidMS
000080393OtherMSBC BS OF MISSISSIPPI
07031277MedicaidMS

Other names 1

  • Ruleville Community Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030624000032 MS Part A Provider - Skilled Nursing Facility 4880504828 Practice locations: Ruleville, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255405205. Details of each certification follow.

Skilled nursing facility certification: CCN 255113

Legal name
RULEVILLE NURSING AND REHABILIATION CENTER LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 1, 1989
Last certification
Nov 30, 2023
Beds
111
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
May 6, 2003 in MS
Enrollment address
800 Stansel Dr Box 368
Ruleville, MS 38771-3320

Care Compare: Nursing home

Medicare Care Compare
Listed as
Ruleville Community Care CenterCCN 255113 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11198.6 residents per day on average
Penalties (3 years)
3Fines totaling $101,474

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0029519Ruleville Community Care Center800 Stansel Dr, Ruleville, MS 38771Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Mississippi Commcare Corporation a Nonprofit Corporation5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

800 Stansel Dr
#368
Ruleville, MS 38771
Phone (662) 756-4361

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Donald T Denz Irrv TR Organization, Buffalo, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 6%
Norbert a Bennett Individual 5% Or Greater Indirect Ownership Interest Jun 30, 2003 32.45%
Donald T Denz Individual 5% Or Greater Indirect Ownership Interest Jun 30, 2003 44%
Norbert a Bennett Irrv TR Fbo Grandchildren Organization, Holland, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 17.55%
Norbert a Bennett Irrv TR Fbo Children Organization, Holland, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 17.55%
Stacy Davis Individual W-2 Managing EmployeeExecutive Director Nov 18, 2019 100%
Renee Klawon Individual OtherIndependent Contractor Aug 14, 2020
D&N, LLC Organization, Orcahrd Park, NY Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Jun 21, 2007 50%
DTD HC LLC Organization, Orchard Park, NY Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Jun 30, 2003 50%

Facilities with the same owner 30

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

View all 30

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

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": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784073600000",
    "number": "1255405205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 W CAUSEWAY APPROACH",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704713082",
            "telephone_number": "504-324-8950",
            "fax_number": "985-624-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 STANSEL DR",
            "city": "RULEVILLE",
            "state": "MS",
            "postal_code": "387713320",
            "telephone_number": "662-756-4361",
            "fax_number": "662-756-2788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI COMMCARE CORPORATION A NON PROFIT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A",
        "authorized_official_last_name": "PSARELLIS",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "HARVEY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "504-324-8950"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007031277",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF MISSISSIPPI",
            "identifier": "000080393",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07031277",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ruleville Community Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ruleville, MS

Sources for this page

Verify at the official NPI Registry.