Organization Active NPI

Community Place

  • Skilled Nursing Facility
  • Jackson, MS
National Provider Identifier
1649363680
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
53 Issued in MS
Legal business name
COMMUNITY PLACE
Practice address
1129 Langley Ave
Jackson, MS 39204-3115
Phone
(601) 355-0617
Fax
(601) 948-7506
NPI assigned
Oct 2, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Anne-Michelle Sabathier Daniel, NHA, MHA
Title
Administrator
Phone
(601) 355-0617

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 53 MS Primary

Addresses

Primary practice location

1129 Langley Ave
Jackson, MS 39204-3115

Mailing address

1129 Langley Ave
Jackson, MS 39204-3115
Phone (601) 355-0617

Other identifiers 1

IdentifierTypeStateIssuer
0023034MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100113000811 MS Part A Provider - Skilled Nursing Facility 8729129648 Practice locations: Brandon, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649363680. Details of each certification follow.

Skilled nursing facility certification: CCN 255285

Legal name
COMMUNITY PLACE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 2002
Last certification
Jan 16, 2025
Beds
60
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 20, 1934 in MS
Enrollment address
116 Lake Vista PL
Brandon, MS 39047-6384
Nursing home name
COMMUNITY PLACE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Community PlaceCCN 255285 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 1, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6055.2 residents per day on average

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
25D0890581Community Place116 Lake Vista Place, Brandon, MS 39047Certificate of waiverAug 21, 2026

National Provider Directory

National Provider Directory

Locations

116 Lake Vista Pl
Brandon, MS 39047
Phone (601) 355-0617

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Charles Morris Individual Corporate OfficerChairman of the Board of Directors Aug 12, 2009 100%
Corporate Director Aug 12, 2009
Rebecca H Shelton Individual Corporate OfficerAuthorized Official Jan 1, 2016
Charles Hill Individual W-2 Managing EmployeeAdministrator Mar 16, 2016 85%
Community Place Organization, Brandon, MS Non-profit Operational/Managerial Control Dec 29, 2020 85%

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649363680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 LANGLEY AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392043115",
            "telephone_number": "601-355-0617",
            "fax_number": "601-948-7506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 LANGLEY AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392043115",
            "telephone_number": "601-355-0617",
            "fax_number": "601-948-7506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY PLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DANIEL",
        "authorized_official_first_name": "ANNE-MICHELLE",
        "authorized_official_middle_name": "SABATHIER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-355-0617",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NHA, MHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "53",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0023034",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.