Active NPI
Meadville LLC
Doing business as Meadville Convalescent Home
- Skilled Nursing Facility
- Meadville, MS
National Provider Identifier
1700872579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 603
- Legal business name
- MEADVILLE LLC
- Doing business as
- Meadville Convalescent Home
- Practice address
- 300 Highway 556
Meadville, MS 39653 - Phone
- (601) 384-5861
- Fax
- (601) 384-5862
- NPI assigned
- Sep 27, 2005
- Last updated
- Jun 20, 2008
- 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
- Rebecca A Rylee, ADMINISTRATOR
- Title
- Administrator
- Phone
- (601) 384-5861
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 603 | MS | Primary |
Addresses
Primary practice location
300 Highway 556
Meadville, MS 39653
Mailing address
300 Highway 556
Meadville, MS 39653
Phone (601) 384-5861
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00230141 | Medicaid | MS |
Other names 1
- Meadville Convalescent Home
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080620000153 | MS | Part A Provider - Skilled Nursing Facility | 9436220324 | Practice locations: Meadville, MS |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1700872579. Details of each certification follow.
Skilled nursing facility certification: CCN 255213
- Legal name
- MEADVILLE LLC
- Doing business as
- MEADVILLE CONVALESCENT HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 1, 1995
- Last certification
- Apr 24, 2024
- Beds
- 60
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Dec 26, 2001 in MS
- Enrollment address
- 300 Highway 556
Meadville Convalescent Home
Meadville, MS 39653-9126 - Nursing home name
- MEADVILLE CONVALESCENT HOME
- Affiliated entity
- CAVALIER HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Meadville Convalescent Home
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Aug 1, 1995
- Medicare certification status
- Active
- Certified beds
- 60
- Chain
- Cavalier Healthcare
National Provider Directory
National Provider DirectoryLocations
300 Highway 556
Meadville, MS 39653
Phone (601) 384-5861
Ownership & related parties
All disclosed owners & managing parties 3
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 |
|---|---|---|---|
| George Guins | 5% Or Greater Direct Ownership Interest | Dec 26, 2001 | 100% |
| Corporate Director | Jun 19, 2008 | ||
| Albert Hornsby | W-2 Managing Employee | Aug 6, 2014 | |
| Meadville LLC | 5% Or Greater Direct Ownership Interest | Dec 26, 2001 | 100% |
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.
-
- Family Medicine Physician
- Flowood, MS
- NPI 1093155376
Affiliated clinicians 4
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": "1127779200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1213920000000",
"number": "1700872579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 HIGHWAY 556",
"city": "MEADVILLE",
"state": "MS",
"postal_code": "39653",
"telephone_number": "601-384-5861",
"fax_number": "601-384-5862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 HIGHWAY 556",
"city": "MEADVILLE",
"state": "MS",
"postal_code": "39653",
"telephone_number": "601-384-5861",
"fax_number": "601-384-5862"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEADVILLE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2005-09-27",
"last_updated": "2008-06-20",
"status": "A",
"authorized_official_last_name": "RYLEE",
"authorized_official_first_name": "REBECCA",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "601-384-5861",
"authorized_official_credential": "ADMINISTRATOR"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "MS",
"license": "603",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00230141",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Meadville Convalescent Home",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Meadville, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; 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.