NPIMap

Organization Active NPI

Mississippi Commcare Corporation a Non Profit Corporation

Doing business as Cleveland Community Care Center

  • Skilled Nursing Facility
  • Cleveland, MS
National Provider Identifier
1891860656
Registry record updated Jul 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
380 Issued in MS
Legal business name
MISSISSIPPI COMMCARE CORPORATION A NON PROFIT CORPORATION
Doing business as
Cleveland Community Care Center
Practice address
4036 Highway 8 East
Cleveland, MS 38732
Phone
(662) 843-4014
Fax
(662) 843-5401
NPI assigned
Nov 21, 2006
Last updated
Jul 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2026

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

Authorized official

Name
Dawn Harvey Psarellis
Title
Vice President
Phone
(504) 324-8950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 380 MS Primary

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 3

IdentifierTypeStateIssuer
005621394MedicaidMS
000080386OtherMSBC BS OF MISSISSIPPI
05621394MedicaidMS

Other names 1

  • Cleveland Community Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030624000028 MS Part A Provider - Skilled Nursing Facility 2264342203 Practice locations: Cleveland, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891860656. Details of each certification follow.

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
LLCProprietary
Incorporated
May 6, 2003 in MS
Enrollment address
4036 Highway 8
Cleveland, MS 38732-8551

Care Compare: Nursing home

Medicare Care Compare
Listed as
Cleveland Community Care CenterCCN 255114 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
120109.6 residents per day on average
Penalties (3 years)
2Fines totaling $229,213

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
25D0672186Cleveland Nursing and Rehabilitation Center4036 Highway 8 East, Cleveland, MS 38732Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Mississippi Commcare Corporation a Nonprofit Corporation5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Donald T Denz Irrv TR Organization, Buffalo, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 6%
Norbert a Bennett Individual 5% Or Greater Indirect Ownership Interest Jun 30, 2003 32.45%
Donald T Denz Individual 5% Or Greater Indirect Ownership Interest Jun 30, 2003 44%
Norbert a Bennett Irrv TR Fbo Grandchildren Organization, Holland, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 17.55%
Norbert a Bennett Irrv TR Fbo Children Organization, Holland, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 17.55%
Kathy Conrad Individual W-2 Managing EmployeeExecutive Director Feb 7, 2020 100%
Renee Klawon Individual OtherIndependent Contractor Aug 14, 2020
D&N, LLC Organization, Orchard Park, NY Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Jun 30, 2003 50%
DTD HC LLC Organization, Orchard Park, NY Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Jun 30, 2003 50%

Facilities with the same owner 30

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

View all 30

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784073600000",
    "number": "1891860656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 W CAUSEWAY APPROACH",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704713082",
            "telephone_number": "504-324-8950",
            "fax_number": "985-624-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4036 HIGHWAY 8 EAST",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "38732",
            "telephone_number": "662-843-4014",
            "fax_number": "662-843-5401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI COMMCARE CORPORATION A NON PROFIT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A",
        "authorized_official_last_name": "PSARELLIS",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "HARVEY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "504-324-8950"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005621394",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF MISSISSIPPI",
            "identifier": "000080386",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05621394",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cleveland Community Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cleveland, MS

Sources for this page

Verify at the official NPI Registry.