Organization Active NPI

WCRL, LLC

Doing business as Willow Creek Retirement Center

  • Skilled Nursing Facility
  • Byram, MS
National Provider Identifier
1780758904
Registry record updated Sep 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
926 Issued in MS
Legal business name
WCRL, LLC
Doing business as
Willow Creek Retirement Center
Practice address
49 Willow Creek LN
Byram, MS 39272-9255
Phone
(601) 863-4201
Fax
(601) 863-4202
NPI assigned
Nov 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2026

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

Authorized official

Name
Mr. David Rotolo
Title
Member
Phone
(601) 853-2667

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 926 MS Primary

Addresses

Primary practice location

49 Willow Creek LN
Byram, MS 39272-9255

Mailing address

PO Box 320939
Flowood, MS 39232-0939
Phone (601) 853-2667

Other identifiers 1

IdentifierTypeStateIssuer
000230143MedicaidMS

Other names 1

  • Willow Creek Retirement Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080220000310 MS Part A Provider - Skilled Nursing Facility 4688758352 Practice locations: Jackson, MS

Skilled nursing facility certification: CCN 255300

Legal name
WCRL, LLC
Doing business as
WILLOW CREEK RETIREMENT CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 1, 2003
Last certification
Nov 7, 2024
Beds
88
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Aug 13, 2007 in MS
Enrollment address
49 Willow Creek Lane
Willow Creek Retirement Center
Jackson, MS 39272-9255
Nursing home name
WILLOW CREEK RETIREMENT CENTER
Affiliated entity
BRIAR HILL MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Willow Creek Retirement CenterCCN 255300 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Aug 1, 2003
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8879.3 residents per day on average
Chain
Briar Hill Management6 facilities in the chain
Penalties (3 years)
1Fines totaling $8,018

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
25D0995919Willow Creek Retirement Center49 Willow Creek Lane, Byram, MS 39272Certificate of waiverFeb 4, 2028

National Provider Directory

National Provider Directory

Locations

49 Willow Creek Ln
Jackson, MS 39272
Phone (601) 863-4201

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Organization, Oneonta, AL LLC, Consulting firm, For-profit Adp of the SNF Apr 4, 2025
Omnicare LLC Organization, Woonsocket, RI LLC, Medical provider/supplier, For-profit Adp of the SNF May 1, 2017
Organization, Jackson, MS Corporation, Financial institution, For-profit Adp of the SNF Apr 24, 2025
Organization, Ambler, PA LLC, Financial institution, For-profit Adp of the SNF Apr 24, 2025
Carrie Whitlow Individual Operational/Managerial Control Sep 5, 2022
Adp of the SNF Sep 5, 2022
David Rotolo Individual 5% Or Greater Direct Ownership InterestOwner Jan 28, 2008 40%
Operational/Managerial Control Jan 28, 2008
Adp of the SNF Jan 28, 2008
Direct Ownership Interest Jan 28, 2008 40%
Organization, Ridgeland, MS LLC, Consulting firm, For-profit Adp of the SNF Apr 4, 2025
Organization, Baton Rouge, LA LLC, Consulting firm, For-profit Adp of the SNF Apr 4, 2025
Robert Rotolo Individual 5% Or Greater Direct Ownership InterestOwner Jan 28, 2008 40%
Operational/Managerial Control Jan 28, 2008
Adp of the SNF Jan 28, 2008
Direct Ownership Interest Jan 28, 2008 40%
Ashley R Muha Individual Operational/Managerial Control Oct 4, 2010
Adp of the SNF Oct 4, 2010
Timothy Duncan Estes Individual Adp of the SNF Nov 11, 2008
Lynn Philippe Individual 5% Or Greater Direct Ownership InterestOwner Jan 28, 2008 20%
Adp of the SNF Jan 28, 2008
Direct Ownership Interest Jan 28, 2008 20%
Donna P Green Individual Operational/Managerial Control May 4, 2010
Adp of the SNF May 4, 2010
Sandy M Burlison Individual Operational/Managerial Control Feb 25, 2019
Adp of the SNF Feb 25, 2019
Briar Hill Management, LLC Organization, Ridgeland, MS LLC, For-profit, Chain home office Operational/Managerial Control Sep 3, 2003
Adp of the SNF Apr 1, 2025
Sharon Ann Burns Individual Operational/Managerial Control Jan 28, 2008
Adp of the SNF Jan 28, 2008
Frosini Rubertino Individual Adp of the SNF Sep 18, 2017
Deborah White Individual Operational/Managerial Control May 12, 2014
Adp of the SNF May 12, 2014
Curtis King Individual Operational/Managerial Control Sep 1, 2016
Adp of the SNF Sep 1, 2016
Johnnie Walters Individual Operational/Managerial Control Jan 12, 2026
Adp of the SNF Jan 12, 2026
WCR LLC Organization, Ridgeland, MS LLC, For-profit Adp of the SNF Jan 28, 2008

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1789948800000",
    "number": "1780758904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 320939",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392320939",
            "telephone_number": "601-853-2667",
            "fax_number": "601-853-2116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 WILLOW CREEK LN",
            "city": "BYRAM",
            "state": "MS",
            "postal_code": "392729255",
            "telephone_number": "601-863-4201",
            "fax_number": "601-863-4202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WCRL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2026-09-21",
        "certification_date": "2026-09-21",
        "status": "A",
        "authorized_official_last_name": "ROTOLO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "601-853-2667",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000230143",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Creek Retirement Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Byram, MS

Sources for this page

Verify at the official NPI Registry.