Humphreys Community Care Center LLC
Organization Active NPI Skilled Nursing Facility · Belzoni, MS
NPI 1891743274 · NPPES record last updated Apr 30, 2013
Key facts
- NPI
- 1891743274
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 405 (MS)
- Legal business name
- HUMPHREYS COMMUNITY CARE CENTER LLC
- Practice address
- 500 CCC Road
Belzoni, MS 39038-3806 - Phone
- (662) 247-1821
- Fax
- (662) 247-2078
- NPI assigned
- May 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Randy Belton
- Title
- Authorized Representative
- Phone
- (601) 709-1408
Owners & managing parties with NPI records 1
Facilities with the same owner 54
Practitioners 2
-
Micah R. Walker, M.D.
Affiliated clinicians 1
Medicare Care Compare: Nursing home
- Listed as
- Humphreys Co Nursing Center
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★☆☆☆☆ 1 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Individual
- Certified
- Jan 1, 2000
- Medicare certification status
- Active
- Certified beds
- 60 · 44.3 residents per day on average
- Chain
- The Beebe Family
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Skilled nursing facility certification: CCN 255259
- Legal name
- HUMPHREYS COMMUNITY CARE CENTER, LLC
- Doing business as
- HUMPHREYS COUNTY NURSING CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 2000
- Last certification
- Dec 12, 2024
- Beds
- 60
- Ownership / control type
- Individual
- Organization structure
- LLC · Proprietary
- Enrollment address
- 500 C C Road
Belzoni, MS 39038-3806 - Nursing home name
- HUMPHREYS CO NURSING CENTER
- Affiliated entity
- THE BEEBE FAMILY
All disclosed owners & managing parties 21
| Name | Role | Since | Share |
|---|---|---|---|
| Elton G. Beebe Sr Irrv Childrens TR |
5% Or Greater Indirect Ownership Interest | Jan 1, 2010 | 85% |
| Adp of the SNF | Jan 1, 2025 | ||
| Elton G Beebe Sr Irrv Grndchildrens TR |
5% Or Greater Direct Ownership Interest | Jan 1, 2010 | 15% |
| Jacqueline Clark |
Operational/Managerial Control | Jun 2, 2021 | |
| Matthew Sumrall |
Operational/Managerial Control | Jul 31, 2023 | |
| Adp of the SNF | Jul 31, 2023 | ||
| Account Management Services Inc |
Operational/Managerial Control | Jan 1, 2010 | |
| Adp of the SNF | Jan 1, 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 | ||
| Sidney Carlton Gorton |
Operational/Managerial Control | Feb 1, 2024 | |
| Adp of the SNF | Feb 1, 2024 | ||
| 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 | ||
| Nutrition Systems Consulting Inc |
Adp of the SNF | Jan 31, 2008 | |
| Humphrey Home LLC |
Adp of the SNF | Jan 1, 2025 | |
| 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, 2023 | |
| Health Care Services, Inc. |
5% Or Greater Direct Ownership Interest | Jan 1, 2010 | 85% |
| Operational/Managerial Control | Jan 1, 2010 | ||
| Adp of the SNF | Jan 1, 2025 | ||
| KH Pitts Consulting LLC |
Adp of the SNF | Oct 1, 2022 | |
| Pharmaceutical Consulting Services of America LLC |
Adp of the SNF | Mar 28, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080108000518 | MS | Part a Provider - Skilled Nursing Facility | 8224118849 | Practice locations: Belzoni, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 405 | MS | Yes |
Addresses
Primary practice location
500 CCC Road
Belzoni, MS 39038-3806
Mailing address
500 CCC Road
Belzoni, MS 39038-3806
Phone (662) 247-1821
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00230170 | Medicaid | MS | |
| 000080383 | Other | MS | BLUE CROSS BLUE SHIELD MS |
Other names
- Humphreys County Nursing Center
Other providers in Belzoni, MS
- Hall Adult Senior Daycare LLC
- Tawana Hawkins
- Lakenya Mims Horton
- House Calls LLC
- Jeffrey B Hughes
- Humphreys County Memorial Hospital
- Humphreys County Memorial Hospital
- Humphreys County Memorial Hospital
- Humphreys County Memorial Hospital
- Humphreys County Memorial Hospital
All providers in Belzoni, MS · Skilled Nursing Facility in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.