NPIMap

Organization Active NPI

CLC of Pascagoula, LLC

  • Skilled Nursing Facility
  • Pascagoula, MS
National Provider Identifier
1992795330
Registry record updated Jan 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
294 Issued in MS
Legal business name
CLC OF PASCAGOULA, LLC
Practice address
4403 Hospital Rd
Pascagoula, MS 39581-5335
Phone
(228) 762-8960
Fax
(228) 769-1820
NPI assigned
Oct 26, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2008

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

Authorized official

Name
Mr. Douglas M. Wright Sr.
Title
Managing Member
Phone
(662) 680-3148

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 294 MS Primary

Addresses

Primary practice location

4403 Hospital Rd
Pascagoula, MS 39581-5335

Mailing address

4403 Hospital Rd
Pascagoula, MS 39581-5335
Phone (228) 762-8960

Other identifiers 1

IdentifierTypeStateIssuer
0230176MedicaidMS

Other names 1

  • Plaza Community Living Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080312000240 MS Part A Provider - Skilled Nursing Facility 2567547748 Practice locations: Pascagoula, MS

Skilled nursing facility certification: CCN 255207

Legal name
CLC OF PASCAGOULA LLC
Doing business as
PLAZA COMMUNITY LIVING CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 1, 1995
Last certification
Jan 9, 2025
Beds
100
Ownership / control type
Corporation
Multi-facility organization
Community Eldercare Services
Organization structure
LLCProprietary
Incorporated
Jul 12, 2000 in MS
Enrollment address
4403 Hospital St
Plaza Community Living Center
Pascagoula, MS 39581-5335
Nursing home name
PLAZA COMMUNITY LIVING CENTER
Affiliated entity
COMMUNITY ELDERCARE SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Plaza Community Living CenterCCN 255207
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Nov 1, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10084.1 residents per day on average
Chain
Community Eldercare Services17 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Community Living Centers, LLC Organization, Tupelo, MS LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Apr 1, 2000 100%
Adp of the SNF Jan 1, 2026
Community Eldercare Services, LLC Organization, Tupelo, MS LLC, Management services company Operational/Managerial Control Apr 1, 2000
Adp of the SNF Jan 1, 2026
Rick D Hoover Individual Operational/Managerial Control Oct 1, 2018
Adp of the SNF Oct 1, 2018
Douglas Wright Individual 5% Or Greater Indirect Ownership InterestManaging Member Apr 1, 2000 100%
Brandie Morace Individual Operational/Managerial Control Apr 14, 2023
Adp of the SNF Apr 1, 2025

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 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 1

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": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201478400000",
    "number": "1992795330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4403 HOSPITAL RD",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815335",
            "telephone_number": "228-762-8960",
            "fax_number": "228-769-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 HOSPITAL RD",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815335",
            "telephone_number": "228-762-8960",
            "fax_number": "228-769-1820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLC OF PASCAGOULA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2008-01-28",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "662-680-3148",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0230176",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plaza Community Living Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pascagoula, MS

Sources for this page

Verify at the official NPI Registry.