Mississippi Commcare Corporation a Non Profit Corporation
Organization Active NPI Skilled Nursing Facility · Cleveland, MS
NPI 1891860656 · NPPES record last updated Jul 15, 2026
Key facts
- NPI
- 1891860656
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 380 (MS)
- Legal business name
- MISSISSIPPI COMMCARE CORPORATION A NON PROFIT CORPORATION
- Practice address
- 4036 Highway 8 East
Cleveland, MS 38732 - Phone
- (662) 843-4014
- Fax
- (662) 843-5401
- NPI assigned
- Nov 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Dawn Harvey Psarellis
- Title
- Vice President
- Phone
- (504) 324-8950
Corporate family (same tax ID) 4
Member of 1
Facilities with the same owner 30
Practitioners 2
Medicare Care Compare: Nursing home
- Listed as
- Cleveland Community Care Center
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Jun 1, 1989
- Medicare certification status
- Active
- Certified beds
- 120 · 109.6 residents per day on average
- Penalties (3 years)
- 2 · fines totaling $229,213
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D0672186 | Cleveland Nursing and Rehabilitation Center | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Skilled nursing facility certification: CCN 255114
- Legal name
- CLEVELAND NURSING AND REHABILITATION CENTER, LLC
- Doing business as
- CLEVELAND NURSING AND REHABILITATION CENTER LLC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jun 1, 1989
- Last certification
- Feb 15, 2024
- Beds
- 120
- Ownership / control type
- Nonprofit Corporation
- Multi-facility organization
- CommCare
- Organization structure
- LLC · Proprietary
- Incorporated
- May 6, 2003 in MS
- Enrollment address
- 4036 Highway 8
Cleveland, MS 38732-8551
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Donald T Denz Irrv TR |
5% Or Greater Indirect Ownership Interest | May 23, 2008 | 6% |
| Norbert a Bennett |
5% Or Greater Indirect Ownership Interest | Jun 30, 2003 | 32.45% |
| Donald T Denz |
5% Or Greater Indirect Ownership Interest | Jun 30, 2003 | 44% |
| Norbert a Bennett Irrv TR Fbo Grandchildren |
5% Or Greater Indirect Ownership Interest | May 23, 2008 | 17.55% |
| Norbert a Bennett Irrv TR Fbo Children |
5% Or Greater Indirect Ownership Interest | May 23, 2008 | 17.55% |
| Kathy Conrad |
W-2 Managing Employee |
Feb 7, 2020 | 100% |
| Renee Klawon |
Other |
Aug 14, 2020 | |
| D&N, LLC |
5% Or Greater Direct Ownership Interest | Jun 30, 2003 | 50% |
| DTD HC LLC |
5% Or Greater Direct Ownership Interest | Jun 30, 2003 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030624000028 | MS | Part a Provider - Skilled Nursing Facility | 2264342203 | Practice locations: Cleveland, MS |
National Provider Directory
- Tax ID family
- Mississippi Commcare Corporation a Nonprofit Corporation
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 380 | MS | Yes |
Addresses
Primary practice location
4036 Highway 8 East
Cleveland, MS 38732
Mailing address
950 W Causeway Approach
Mandeville, LA 70471-3082
Phone (504) 324-8950
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05621394 | Medicaid | MS | |
| 005621394 | Medicaid | MS | |
| 000080386 | Other | MS | BC BS OF MISSISSIPPI |
Other names
- Cleveland Community Care Center
Other providers in Cleveland, MS
- Mid Delta Family Practice Clinic
- Mid Delta Family Practice Clinic
- Mid Delta Family Practice Clinic II Inc
- Derek Miles
- Milestone Hospice Incorporated
- Mississippi Methodist Hospital & Rehabilitation Center, Inc.
- Mississippi State Department of Health
- Mississippi Visiting Physicians, LLC
- Jasmine Mitchell
- Clare Adams Moore
All providers in Cleveland, 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 Jul 15, 2026. 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.