Pecan Grove in Ellisville - Nursing Facility/intermediate Care Facility
Pecan Grove - NPI 1205904604
Pecan Grove is a Nursing Facility/intermediate Care Facility in Ellisville, Mississippi. Pecan Grove practices all healthcare services and medical treatments related to Nursing Facility/intermediate Care Facility. The NPI Number for Pecan Grove is 1205904604. The last update date is 2020-08-22.
Pecan Grove's current location address is 1101 Highway 11 S, Ellisville, Mississippi. You can contact this provider via phone number 6014779384 and fax number 6014775700. The mailing address for Pecan Grove is 1101 Highway 11 S, Ellisville, Mississippi. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Pecan Grove |
|---|---|
| Address | 1101 Highway 11 S, Ellisville, Mississippi |
| Phone Number | 6014779384 |
| Fax Number | 6014775700 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | DIRECTOR O |
|---|---|
| Authorized Official Name | Lassiter Suzie |
| Telephone Number | 6014779384 |
NPI Number Detail
| NPI Number | 1205904604 |
|---|---|
| Provider Enumeration Date | 2006-12-01 |
| Last Updated Date | 2020-08-22 |
Provider Mailing Address Detail
| Address | 1101 Highway 11 S |
|---|---|
| City | Ellisville |
| State | Mississippi (MS) |
| Post Code | 394374443 |
| Phone Number | 6014779384 |
| Fax Number | 6014775700 |
Provider's Primary Taxonomy Detail
| Speciality | Nursing Facility/intermediate Care Facility |
|---|---|
| Taxonomy | 313M00000X |
| Licence No | 284 |
|
Definition: An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the reha |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 21847 | MS | -- |
Post Comment/ Review Below
What is the unique identifier code issued to Pecan Grove by the Centers for Medicare & Medicaid Services?
The Pecan Grove has been assigned the NPI (National Provider Identifier) 1205904604. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Could you provide the complete physical address where Pecan Grove is located?
The Pecan Grove is situated at the following address: 1101 Highway 11 S, Ellisville, MS, 394374443.
What is Pecan Grove's primary field of medical specialization, and what is the corresponding taxonomy classification code for this area of expertise?
The primary field of medical specialization for Pecan Grove is Nursing Facility/intermediate Care Facility, and the taxonomy classification code that categorizes this area of expertise is 313M00000X.
On what date did the Pecan Grove receive the assignment of its 1205904604 from the Centers for Medicare & Medicaid Services?
The Pecan Grove was issued its 1205904604 by the Centers for Medicare & Medicaid Services on 2006-12-01.
As of what date were the details pertaining to Pecan Grove last refreshed?
The information related to the Pecan Grove, including its address, specialty, and other relevant details, was last updated on 2020-08-22.
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