PECAN GROVE NPI 1205904604

NPI Information

  • NPI: 1205904604
  • Provider Name: PECAN GROVE
  • Classification: Nursing Facility/Intermediate Care Facility - 313M00000X
  • Entity Type: Organization
  • Address: 1101 HIGHWAY 11 S
    ELLISVILLE, MS
    ZIP 39437
  • Phone: (601) 477-9384

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NPI Details

PECAN GROVE is a nursing facility intermediate care facility in Ellisville, MS. The provider is 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 rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. PECAN GROVE NPI is 1205904604. The provider is registered as an organization entity type.

The provider's business location address is:

1101 HIGHWAY 11 S
ELLISVILLE, MS
ZIP 39437-443
Phone: (601) 477-9384
Fax: (601) 477-5700

The provider's authorized official is Suzie Lassiter .
The authorized official title is Director Of Facility and has the following contact phone number (601) 477-9384.

The enumeration date for this NPI number is 12/1/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1313M00000XNursing Facility/Intermediate Care Facility284MISSISSIPPIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100021847MEDICAIDMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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