TISHOMINGO MANOR
NPI 1194773515
Skilled Nursing Facility in Iuka, MS

Active since May 05, 2006CLIA 25D0885515 · Waiver
230 KAKI AVE, IUKA, MS 38852(662) 423-9112(662) 423-9121 Get Directions Write a Review

NPPES record last updated: April 30, 2013. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Tishomingo Manor NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TISHOMINGO MANOR (NPI 1194773515) is a healthcare organization registered as a skilled nursing facility in Iuka, Mississippi and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through April 21, 2028 and lists Toni Parkinson, Authorized Representative, as its authorized official.

NPPES Registry Identity

NPI1194773515
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameTISHOMINGO COMMUNITY CARE CENTER LLC
Location Address230 KAKI AVEIuka, MS 38852-1192
Mailing Address230 Kaki AveIuka, MS 38852-1192 · (662) 423-9112 · Fax (662) 423-9121
Fax(662) 423-9121
Organization SubpartNo
Authorized OfficialToni ParkinsonAuthorized Representative · (601) 709-1408
Enumeration DateMay 5, 2006
Last NPPES UpdateApril 30, 2013
NPI 1194773515 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in MS · 414
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
230 KAKI AVE, Iuka, MS 38852

Other Names 1

Doing Business AsTishomingo Manor

Other Identifiers 3

Medicaid00230109MS
Medicare OSCAR/certification255218MS
Other80488MS · Blue Cross Blue Shield

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D0885515

Tishomingo Manor · Iuka, MS
Active · expires Apr 21, 2028
CLIA Number25D0885515
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateApril 22, 2026
Certificate Expiration DateApril 21, 2028
Laboratory DirectorJennifer Cain
Laboratory Phone(662) 423-9112
Laboratory LocationTishomingo Manor230 Kaki Street, Iuka, MS 38852
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tishomingo Community Care Center LLC's NPI number?

The NPI number for Tishomingo Community Care Center LLC is 1194773515. It was assigned to this organization in the NPPES registry on May 5, 2006. The provider is doing business as Tishomingo Manor.

Where is Tishomingo Community Care Center LLC located?

Tishomingo Community Care Center LLC is located at 230 Kaki Ave, Iuka, MS 38852. The listed phone number is (662) 423-9112.

What is Tishomingo Community Care Center LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Tishomingo Community Care Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D0885515) is associated with this NPI, valid through April 21, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Tishomingo Community Care Center LLC was last updated on April 30, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.