National Provider Identifier Database

ELLISVILLE STATE SCHOOL
Intermediate Care Facility, Mentally Retarded

(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.


Contact Information

ELLISVILLE STATE SCHOOL
1101 HWY 11 S
ELLISVILLE, MS39437-4443
Phone: 601-477-5607
Fax: 601-477-5700
Website:
Specialty Taxonomy Code
* Intermediate Care Facility, Mentally Retarded 315P00000X

* Indicates primary specialty

NPI Profile & details for ELLISVILLE STATE SCHOOL

NPI Number 1285947408
Legal business name
LBN
ELLISVILLE STATE SCHOOL
Authorized official RENE'E BRETT - (DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 07/16/2010
Last updated 01/27/2011 - About 15 years ago
Sole proprietor1 Not specified
Identifiers
  • MS Medicaid: 05850722

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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