Kemper County LTC Inc
Organization Active NPI Skilled Nursing Facility · Dekalb, MS
NPI 1609866235 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1609866235
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 358 (MS)
- Legal business name
- KEMPER COUNTY LTC INC
- Practice address
- 220 Willow Ave
Dekalb, MS 39328-0577 - Phone
- (601) 743-5888
- Fax
- (601) 743-4506
- NPI assigned
- Oct 25, 2005
- Organization subpart
- No
Authorized official
- Name
- Mrs. Patty C Nester, NHA
- Title
- Administrator
- Phone
- (601) 743-5888
Owners & managing parties with NPI records 1
Practitioners 2
-
Russell E. Belenchia, D.O.
Affiliated clinicians 2
-
Russell E. Belenchia, D.O.
Medicare Care Compare: Nursing home
- Listed as
- Ms Care Center of Dekalb
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★★★★★ 5 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Nov 1, 1997
- Medicare certification status
- Active
- Certified beds
- 60 · 55.2 residents per day on average
- Chain
- Mississippi Care Center
- Penalties (3 years)
- 2 · fines totaling $10,358
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Skilled nursing facility certification: CCN 255251
- Legal name
- KEMPER COUNTY LTC INC
- Doing business as
- MS CARE CENTER OF DEKALB
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 1, 1997
- Last certification
- May 8, 2024
- Beds
- 60
- Ownership / control type
- Corporation
- Most recent change of ownership
- Nov 1, 2004
- Organization structure
- Corporation · Proprietary
- Incorporated
- Sep 9, 2004 in MS
- Enrollment address
- 205 Willow Ave
De Kalb, MS 39328-6000 - Nursing home name
- MS CARE CENTER OF DEKALB
- Affiliated entity
- MISSISSIPPI CARE CENTER
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Rebecca H Shelton |
Corporate Director |
Jan 1, 2008 | |
| Harold M Beebe |
Corporate Director | Nov 1, 2004 | |
| Ruby Bolen |
Operational/Managerial Control | Dec 26, 2008 | |
| Adp of the SNF | Dec 26, 2008 | ||
| Steven L Delaney |
5% Or Greater Direct Ownership Interest | Nov 1, 2004 | 50% |
| Corporate Director | Oct 28, 2004 | 50% | |
| Olugboyega Ransome-Kuti |
Adp of the SNF | Jan 1, 2010 | |
| Garry H Pace |
5% Or Greater Direct Ownership Interest | Aug 9, 2004 | 50% |
| Corporate Director | Oct 27, 2004 | 50% | |
| Operational/Managerial Control | Oct 27, 2004 | ||
| Adp of the SNF | Oct 27, 2004 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041027001269 | MS | Part a Provider - Skilled Nursing Facility | 6305808841 | Practice locations: De Kalb, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 358 | MS | Yes |
Addresses
Primary practice location
220 Willow Ave
Dekalb, MS 39328-0577
Mailing address
PO Box 577
De Kalb, MS 39328-0577
Phone (601) 743-5888
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0230087 | Medicaid | MS |
Other names
- Mississippi Care Center of DeKalb LLC
Other providers in Dekalb, MS
- Bio-Medical Applications of Mississippi, Inc.
- Emmanuel Ridge of Dekalb Inc
- Haley Ezelle
- Mississippi State Department of Health
- Proxsys RX - Rush LLC
- Region Ten Commission on Mental Health
- James Waldo Vandevender
- Darrell J Zehr
All providers in Dekalb, 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 Aug 22, 2020. 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.