Active NPI
Community Place
- Skilled Nursing Facility
- Jackson, MS
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 53
- 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, 2020
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0023034 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Corporation
- 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 Place
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Apr 1, 2002
- Medicare certification status
- Active
- Certified beds
- 60
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D0890581 | Community Place | Certificate of waiver | Aug 21, 2026 |
National Provider Directory
National Provider DirectoryLocations
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Charles Morris | Corporate Officer | Aug 12, 2009 | 100% |
| Corporate Director | Aug 12, 2009 | ||
| Rebecca H Shelton | Corporate Officer | Jan 1, 2016 | |
| Charles Hill | W-2 Managing Employee | Mar 16, 2016 | 85% |
| Community Place | 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.
-
- General Practice Physician
- Jackson, MS
- NPI 1285746511
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.