Pecan Grove
NPI #1205904604 in Ellisville, Mississippi
Provider Information
- NPI Number
- 1205904604
- Entity Type
- Organization
- Organization Name
- Pecan Grove
- Primary Specialty
- Nursing Facility/Intermediate Care Facility
- Enumeration Date
- Dec 1, 2006
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 1101 HIGHWAY 11 S
- City
- Ellisville
- State
- Mississippi
- ZIP Code
- 39437-4443
- Phone
- (601) 477-9384
Authorized Official
- Name
- SUZIE LASSITER
- Title
- DIRECTOR OF FACILITY
- Phone
- (601) 477-9384
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nursing Facility/Intermediate Care Facility |
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