Active NPI
Copiah Community Care Center LLC
Doing business as Copiah Living Center
- Skilled Nursing Facility
- Crystal Springs, MS
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 949
- Legal business name
- COPIAH COMMUNITY CARE CENTER LLC
- Doing business as
- Copiah Living Center
- Practice address
- 806 W Georgetown St
Crystal Springs, MS 39059-9453 - Phone
- (601) 892-1881
- Fax
- (601) 892-1985
- NPI assigned
- May 4, 2006
- Last updated
- Apr 30, 2013
- 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. Toni Parkinson
- Title
- Authorized Representative
- Phone
- (601) 709-1408
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 949 | MS | Primary |
Addresses
Primary practice location
806 W Georgetown St
Crystal Springs, MS 39059-9453
Mailing address
806 W Georgetown St
Crystal Springs, MS 39059-9453
Phone (601) 892-1881
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 80413 | Other | MS | BLUE CROSS BLUE SHIELD |
| 00230165 | Medicaid | MS |
Other names 1
- Copiah Living Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071220000212 | MS | Part A Provider - Skilled Nursing Facility | 2668562109 | Practice locations: Crystal Springs, MS |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1720036916. Details of each certification follow.
Skilled nursing facility certification: CCN 255291
- Legal name
- COPIAH COMMUNITY CARE CENTER, LLC
- Doing business as
- COPIAH LIVING CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Sep 1, 2002
- Last certification
- May 8, 2025
- Beds
- 60
- Ownership / control type
- Corporation
- Organization structure
- LLC
- Enrollment address
- 806 W Georgetown St
Crystal Springs, MS 39059-9453 - Nursing home name
- COPIAH LIVING CENTER
- Affiliated entity
- THE BEEBE FAMILY
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Copiah Living Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Sep 1, 2002
- Medicare certification status
- Active
- Certified beds
- 60
- Chain
- The Beebe Family
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 |
|---|---|---|---|
| 25D0992552 | Copiah Living Center | Certificate of waiver | Oct 18, 2027 |
National Provider Directory
National Provider DirectoryLocations
806 W Georgetown St
Crystal Springs, MS 39059
Phone (601) 473-6915
Ownership & related parties
All disclosed owners & managing parties 23
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 |
|---|---|---|---|
| Elton G Beebe Sr Irrv Grndchildrens TR | 5% Or Greater Direct Ownership Interest | Jan 1, 2010 | 15% |
| Bobby Blackard | Operational/Managerial Control | Sep 16, 2021 | |
| Adp of the SNF | Sep 16, 2021 | ||
| QSST TR for Alison Beebe Sadler Danos and Her Descendants | 5% Or Greater Indirect Ownership Interest | Nov 1, 2013 | 28.34% |
| Adp of the SNF | Jan 1, 2025 | ||
| Medico LLC | 5% Or Greater Direct Ownership Interest | Jan 1, 2010 | 85% |
| Operational/Managerial Control | Jan 1, 2010 | ||
| Adp of the SNF | Jan 1, 2025 | ||
| Copiah Community Care Center, LLC | Adp of the SNF | Jan 1, 2025 | |
| Account Management Services Inc | Operational/Managerial Control | Jan 1, 2010 | |
| Adp of the SNF | Jan 1, 2010 | ||
| Regional Care LLC | Operational/Managerial Control | Jan 1, 2014 | |
| Elton G Beebe | 5% Or Greater Indirect Ownership Interest | Jan 1, 2010 | 28.33% |
| Operational/Managerial Control | Jan 1, 2010 | ||
| Adp of the SNF | Jan 1, 2025 | ||
| Robert L Walker | Operational/Managerial Control | Sep 27, 2010 | |
| Adp of the SNF | Sep 27, 2010 | ||
| Linda Maynor | Adp of the SNF | Jan 1, 2011 | |
| Regional Services, Inc | Operational/Managerial Control | Jan 1, 2023 | |
| Adp of the SNF | Jan 1, 2023 | ||
| Toni H Parkinson | Corporate Officer | Nov 15, 2015 | |
| Operational/Managerial Control | Jan 1, 2010 | ||
| Adp of the SNF | Jan 1, 2010 | ||
| Provider Professional Services Inc | Operational/Managerial Control | Jan 1, 2010 | |
| Adp of the SNF | Jan 1, 2010 | ||
| Lizabeth Gallagher | Operational/Managerial Control | Feb 15, 2022 | |
| Nutrition Systems Consulting Inc | Adp of the SNF | Jan 31, 2008 | |
| Administrative Systems Inc | Operational/Managerial Control | Jan 1, 2010 | |
| Adp of the SNF | Jan 1, 2010 | ||
| David W Stallard | Operational/Managerial Control | Jan 1, 2010 | |
| Adp of the SNF | Jan 1, 2010 | ||
| Bobby L Beebe | Operational/Managerial Control | Jan 1, 2023 | |
| Adp of the SNF | Jan 1, 2023 | ||
| Providence Care LLC | Operational/Managerial Control | Jan 1, 2010 | |
| Adp of the SNF | Jan 1, 2010 | ||
| Tristar Rehab Inc | Operational/Managerial Control | Jan 1, 2024 | |
| Adp of the SNF | Jan 1, 2024 | ||
| David a Flippin | Operational/Managerial Control | Jan 1, 2014 | |
| QSST TR for Felicia Beebe Stallard and Her Descendants | 5% Or Greater Indirect Ownership Interest | Nov 1, 2013 | 28.33% |
| Adp of the SNF | Jan 1, 2025 | ||
| Pharmaceutical Consulting Services of America LLC | Adp of the SNF | Mar 28, 2018 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Emergency Medicine Physician
- Hazlehurst, MS
- NPI 1649216680
Adp of the SNF, Operational/Managerial Control
Facilities with the same owner 55
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Legacy Manor Nursing & Rehabilitation Center
- Skilled Nursing Facility
- Greenville, MS
- NPI 1447208228
Account Management Services Inc, Administrative Systems Inc, Provider Professional Services Inc, Regional Care LLC, Regional Services, Inc, Tristar Rehab Inc
-
dba Attala County Nursing Center
- Skilled Nursing Facility
- Kosciusko, MS
- NPI 1215985429
Account Management Services Inc, Administrative Systems Inc, Elton G Beebe Sr Irrv Grndchildrens TR, Medico LLC, Providence Care LLC, Provider Professional Services Inc, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia
-
dba Clarksdale Nursing Center
- Skilled Nursing Facility
- Clarksdale, MS
- NPI 1740238930
Account Management Services Inc, Administrative Systems Inc, Provider Professional Services Inc
-
dba Landmark of Collins
- Skilled Nursing Facility
- Collins, MS
- NPI 1215985734
Account Management Services Inc, Administrative Systems Inc, Elton G Beebe Sr Irrv Grndchildrens TR, Medico LLC, Providence Care LLC, Provider Professional Services Inc, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia
-
dba The Myrtles Nursing Center
- Skilled Nursing Facility
- Columbia, MS
- NPI 1467400242
Account Management Services Inc, Administrative Systems Inc, Provider Professional Services Inc, Regional Care LLC, Regional Services, Inc, Tristar Rehab Inc
-
dba Care Center of Aberdeen
- Skilled Nursing Facility
- Aberdeen, MS
- NPI 1063628451
Account Management Services Inc, Administrative Systems Inc, Provider Professional Services Inc, Regional Care LLC, Regional Services, Inc, Tristar Rehab Inc
-
dba Grenada Living Center
- Skilled Nursing Facility
- Grenada, MS
- NPI 1477501922
Account Management Services Inc, Administrative Systems Inc, Provider Professional Services Inc, Regional Care LLC, Regional Services, Inc, Tristar Rehab Inc
-
dba Care Center of Laurel
- Skilled Nursing Facility
- Laurel, MS
- NPI 1518094358
Account Management Services Inc, Administrative Systems Inc, Provider Professional Services Inc, Regional Care LLC, Regional Services, Inc, Tristar Rehab Inc
-
dba Heritage House Nursing Center
- Skilled Nursing Facility
- Vicksburg, MS
- NPI 1225086374
Account Management Services Inc, Administrative Systems Inc, Medico LLC, Providence Care LLC, Provider Professional Services Inc, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia Beebe Stallard and Her Descendants, Reg
-
dba Landmark of Desoto
- Skilled Nursing Facility
- Horn Lake, MS
- NPI 1831147677
Account Management Services Inc, Administrative Systems Inc, Elton G Beebe Sr Irrv Grndchildrens TR, Providence Care LLC, Provider Professional Services Inc, Regional Care LLC, Regional Services, Inc, Tristar Rehab Inc
-
dba Gulfport Care Center
- Skilled Nursing Facility
- Gulfport, MS
- NPI 1538582143
Account Management Services Inc, Administrative Systems Inc, Medico LLC, Providence Care LLC, Provider Professional Services Inc, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia Beebe Stallard and Her Descendants, Reg
-
dba Humphreys County Nursing Center
- Skilled Nursing Facility
- Belzoni, MS
- NPI 1891743274
Account Management Services Inc, Administrative Systems Inc, Elton G Beebe Sr Irrv Grndchildrens TR, Providence Care LLC, Provider Professional Services Inc, Regional Services, Inc, Tristar Rehab Inc
Practitioners & affiliated clinicians
Practitioners 3
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
- Hazlehurst, MS
- NPI 1235231606
-
- Family Medicine Physician
- Hazlehurst, MS
- NPI 1285863886
-
- Emergency Medicine Physician
- Hazlehurst, MS
- NPI 1649216680
Affiliated clinicians 4
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Family Medicine Physician
- Crystal Springs, MS
- NPI 1619903580
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1367280000000",
"number": "1720036916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "806 W GEORGETOWN ST",
"city": "CRYSTAL SPRINGS",
"state": "MS",
"postal_code": "390599453",
"telephone_number": "601-892-1881",
"fax_number": "601-892-1985"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "806 W GEORGETOWN ST",
"city": "CRYSTAL SPRINGS",
"state": "MS",
"postal_code": "390599453",
"telephone_number": "601-892-1881",
"fax_number": "601-892-1985"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COPIAH COMMUNITY CARE CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-04",
"last_updated": "2013-04-30",
"status": "A",
"authorized_official_last_name": "PARKINSON",
"authorized_official_first_name": "TONI",
"authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
"authorized_official_telephone_number": "601-709-1408",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "MS",
"license": "949",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "80413",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00230165",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Copiah Living Center",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Crystal Springs, MS
- City Drug, LLC
- City Drugs of Crystal Springs, Inc. (City Drugs)
- Donald Lonzo Comfort II, PHARMD
- Comforting Hands Healthcare
- Community Connections & Networks LLC
- Copiah County Family Resource Center
- Copiah County Medical Center (Crystal Springs Clinic)
- Crystal Springs Dental Center, LLC
- Drayer Physical Therapy Mississippi LLC
- Emanuel Unlimited
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2013; 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.