NPIMap

Organization Active NPI

Mississippi Commcare Corporation a Non Profit Corporation

Doing business as McComb Community Care Center

  • Skilled Nursing Facility
  • McComb, MS
National Provider Identifier
1700950789
Registry record updated Jul 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
886 Issued in MS
Legal business name
MISSISSIPPI COMMCARE CORPORATION A NON PROFIT CORPORATION
Doing business as
McComb Community Care Center
Practice address
415 Marion Ave
McComb, MS 39648-2709
Phone
(601) 684-8700
Fax
(601) 249-2982
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 886 MS Primary

Addresses

Primary practice location

415 Marion Ave
McComb, MS 39648-2709

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
00036212MedicaidMS
000036212MedicaidMS
000080385OtherMSBC BS OF MISSISSIPPI

Other names 1

  • McComb 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
O20030624000021 MS Part A Provider - Skilled Nursing Facility 7810807856 Practice locations: McComb, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700950789. Details of each certification follow.

Skilled nursing facility certification: CCN 255101

Legal name
MCCOMB NURSING AND REHABILITATION CENTER LLC
Doing business as
MCCOMB NURSING AND REHABILITATION CENTER, LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1989
Last certification
Sep 13, 2024
Beds
140
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
May 6, 2003 in MS
Enrollment address
415 Marion Ave
McComb, MS 39648-2709

Care Compare: Nursing home

Medicare Care Compare
Listed as
McComb Community Care CenterCCN 255101 · All quality measures
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Apr 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
140105.6 residents per day on average
Penalties (3 years)
1Fines totaling $12,740

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
25D0676599McComb Nursing and Rehabilitation Center415 Marion Avenue, McComb, MS 39648Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

415 Marion Ave
McComb, MS 39648
Phone (601) 584-8700

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%
Rhonda Smith Individual W-2 Managing EmployeeExecutive Director May 27, 2015 100%
Norbert a Bennett Irrv TR Fbo Children Organization, Holland, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 17.55%
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 30, 2003 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": "1700950789",
    "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": "415 MARION AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482709",
            "telephone_number": "601-684-8700",
            "fax_number": "601-249-2982"
        }
    ],
    "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": "886",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00036212",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000036212",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF MISSISSIPPI",
            "identifier": "000080385",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McComb Community Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McComb, MS

Sources for this page

Verify at the official NPI Registry.