Ellisville State School
NPI #1811135718 in Ellisville, Mississippi
Provider Information
- NPI Number
- 1811135718
- Entity Type
- Organization
- Organization Name
- Ellisville State School
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- Jan 30, 2009
- Last Updated
- Jan 30, 2009
Practice Location
- Address
- 1101 HWY 11 S
- City
- Ellisville
- State
- Mississippi
- ZIP Code
- 39437-4443
- Phone
- (601) 477-5770
Authorized Official
- Name
- MRS. STEPHANIE D. SMITH
- Title
- FAMILY NURSE PRACTITIONER
- Phone
- (601) 477-5770
Specialties & Taxonomy Codes
| Specialty |
|---|
| Intermediate Care Facility, Intellectual Disabilities |
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