MEDICARE: MISSISSIPPI COMMCARE CORPORATION A NON PROFIT CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	380	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000080386	OTHER	MS	BC BS OF MISSISSIPPI

General Provider Information

NPI Number	:	1891860656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSISSIPPI COMMCARE CORPORATION A NON PROFIT CORPORATION

Provider Business Mailing Address
First Line	:	950 W CAUSEWAY APPROACH
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3082
Country	:	US
Telephone Number	:	504-324-8950
Fax Number	:	985-624-3477

Provider Business Practice Location Address
First Line	:	4036 HIGHWAY 8 EAST
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732
Country	:	US
Telephone Number	:	662-843-4014
Fax Number	:	662-843-5401

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DAWN HARVEY PSARELLIS
Credential	:
Telephone Number	:	504-324-8950

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	05/15/2026

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