Active NPI
WCRL, LLC
Doing business as Willow Creek Retirement Center
- Skilled Nursing Facility
- Byram, MS
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 926
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000230143 | Medicaid | MS |
Other names 1
- Willow Creek Retirement 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 |
|---|---|---|---|---|
| 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
- LLC
- 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 Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Aug 1, 2003
- Medicare certification status
- Active
- Certified beds
- 88
- Chain
- Briar Hill Management
- Penalties (3 years)
- 1
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 |
|---|---|---|---|
| 25D0995919 | Willow Creek Retirement Center | Certificate of waiver | Feb 4, 2028 |
National Provider Directory
National Provider DirectoryLocations
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Adp of the SNF | Apr 4, 2025 | ||
| Omnicare LLC | Adp of the SNF | May 1, 2017 | |
| Adp of the SNF | Apr 24, 2025 | ||
| Adp of the SNF | Apr 24, 2025 | ||
| Carrie Whitlow | Operational/Managerial Control | Sep 5, 2022 | |
| Adp of the SNF | Sep 5, 2022 | ||
| David Rotolo | 5% Or Greater Direct Ownership Interest | Jan 28, 2008 | 40% |
| Operational/Managerial Control | Jan 28, 2008 | ||
| Adp of the SNF | Jan 28, 2008 | ||
| Direct Ownership Interest | Jan 28, 2008 | 40% | |
| Adp of the SNF | Apr 4, 2025 | ||
| Adp of the SNF | Apr 4, 2025 | ||
| Robert Rotolo | 5% Or Greater Direct Ownership Interest | 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 | Operational/Managerial Control | Oct 4, 2010 | |
| Adp of the SNF | Oct 4, 2010 | ||
| Timothy Duncan Estes | Adp of the SNF | Nov 11, 2008 | |
| Lynn Philippe | 5% Or Greater Direct Ownership Interest | Jan 28, 2008 | 20% |
| Adp of the SNF | Jan 28, 2008 | ||
| Direct Ownership Interest | Jan 28, 2008 | 20% | |
| Donna P Green | Operational/Managerial Control | May 4, 2010 | |
| Adp of the SNF | May 4, 2010 | ||
| Sandy M Burlison | Operational/Managerial Control | Feb 25, 2019 | |
| Adp of the SNF | Feb 25, 2019 | ||
| Briar Hill Management, LLC | Operational/Managerial Control | Sep 3, 2003 | |
| Adp of the SNF | Apr 1, 2025 | ||
| Sharon Ann Burns | Operational/Managerial Control | Jan 28, 2008 | |
| Adp of the SNF | Jan 28, 2008 | ||
| Frosini Rubertino | Adp of the SNF | Sep 18, 2017 | |
| Deborah White | Operational/Managerial Control | May 12, 2014 | |
| Adp of the SNF | May 12, 2014 | ||
| Curtis King | Operational/Managerial Control | Sep 1, 2016 | |
| Adp of the SNF | Sep 1, 2016 | ||
| Johnnie Walters | Operational/Managerial Control | Jan 12, 2026 | |
| Adp of the SNF | Jan 12, 2026 | ||
| WCR LLC | 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.
-
dba Briar Hill Rest Home
- Skilled Nursing Facility
- Florence, MS
- NPI 1770558215
Briar Hill Management, LLC
-
dba The Carrington
- Skilled Nursing Facility
- Starkville, MS
- NPI 1023182235
Briar Hill Management, LLC
-
dba The Nichols Center
- Skilled Nursing Facility
- Madison, MS
- NPI 1316011513
Briar Hill Management, LLC
-
dba River Place Nursing Center
- Skilled Nursing Facility
- Amory, MS
- NPI 1316011695
Briar Hill Management, LLC
-
dba Vineyard Court Nursing Center
- Skilled Nursing Facility
- Columbus, MS
- NPI 1891869012
Briar Hill Management, LLC
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- General Practice Physician
- Jackson, MS
- NPI 1285746511
-
- Family Medicine Physician
- Flowood, MS
- NPI 1093155376
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2026; 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.