ELLISVILLE STATE SCHOOL (NPI# 1285947408) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285947408 |
| Entity Type | Organization |
| Organization Name | ELLISVILLE STATE SCHOOL |
| Practice Address |
1101 Hwy 11 S Ellisville MS 39437-4443 |
| Practice Telephone | 6014775607 |
| Practice Fax Number | 6014775700 |
| Mailing Telephone | 6014775607 |
| Mailing Fax Number | 6014775700 |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2011-01-27 |
| Authorized Official Name | MRS. RENE'E BRETT (DIRECTOR) |
| Authorized Official Telephone | 6014775595 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 05850722 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568468080 | Ellisville State School | Clinic/Center | 1101 Hwy 11 S, Ellisville, MS 39437-4444 | 2005-06-21 |
| 1811135718 | Ellisville State School | Intermediate Care Facility, Mentally Retarded | 1101 Hwy 11 S, Ellisville, MS 39437-4443 | 2009-01-30 |
| 1164582821 | Ellisville State School | Technician | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-12-11 |
| 1578668901 | Ellisville State School | Pharmacy | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-09-13 |
| 1720181191 | Ellisville State School | Health Maintenance Organization | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-09-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ELLISVILLE STATE SCHOOL | 1101 Highway 11 S Eville, Ellisville, MS 39437-4443 |
| Street Address |
1101 HWY 11 S |
| City | ELLISVILLE |
| State | MS |
| Zip Code | 39437-4443 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568468080 | Ellisville State School | Clinic/Center | 1101 Hwy 11 S, Ellisville, MS 39437-4444 | 2005-06-21 |
| 1003055005 | Stephanie D. Smith | Nurse Practitioner | 1101 Hwy 11 S, Ellisville, MS 39437-4443 | 2009-02-13 |
| 1811135718 | Ellisville State School | Intermediate Care Facility, Mentally Retarded | 1101 Hwy 11 S, Ellisville, MS 39437-4443 | 2009-01-30 |
| 1194743138 | Rushikesh H. Mehta | Pediatrics | 1101 Hwy 11 S, Ellisville State School, Ellisville, MS 39437-4443 | 2006-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881227759 | Courtney J. Sims | Nurse Practitioner | 80 Hal Crocker Road, Ellisville, MS 39437 | 2020-02-19 |
| 1891228581 | Magnolia Gardens Assisted Living | Assisted Living Facility | 303 East Ivy, Ellisville, MS 39437 | 2017-04-10 |
| 1972851814 | Dental Group of Ellisville, Pllc | Dentist | 97 Hal Crocker Road, Ellisville, MS 39437 | 2012-08-27 |
| 1891920518 | Amy E Young | Speech-Language Pathologist | 471 Hwy 590, Ellisville, MS 39437 | 2009-05-26 |
| 1053486852 | Natalia Angelia Stevenson | Nurse Practitioner | Ellisville State School, 1101 Hwy 11 South, Ellisville, MS 39437 | 2006-11-21 |
| 1831275189 | Womens Pavilion of South Mississippi, Pllc | Obstetrics & Gynecology | 1242 Hwy 29 North, Ellisville, MS 39437 | 2006-10-30 |
| 1861578635 | Jennifer Reeder Mascagni | Nurse Practitioner | 1203 Ave B Ste 200, Ellisville, MS 39437 | 2006-10-27 |
| 1851499982 | Kathleen Frances Mccoy | Physical Therapist | 1101 Hwy 11 South, Ellisville, MS 39437 | 2006-09-20 |
| 1861498610 | Patricia A. Tibbs | Pediatrics | 1203 Avenue B, Ellisville, MS 39437 | 2005-06-27 |
| 1700954765 | Shelia Dianne Bradford | Nurse Practitioner | 1203 Avenue B, Ellisville, MS 39437 | 2006-11-30 |
| Find all providers in zip 39437 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | 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. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811135718 | Ellisville State School | Intermediate Care Facility, Mentally Retarded | 1101 Hwy 11 S, Ellisville, MS 39437-4443 | 2009-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578703583 | F Lee Neal Jr Md Pa | Intermediate Care Facility, Mentally Retarded | 717 S Church St, Brookhaven, MS 39601-3811 | 2009-03-03 |
| 1750448718 | Hudspeth Regional Center | Intermediate Care Facility, Mentally Retarded | Highway 475 South, Whitfield, MS 39193 | 2007-01-02 |
| 1326068834 | Boswell Regional Center | Intermediate Care Facility, Mentally Retarded | 1049 Simpson Highway 149 South, Magee, MS 39111-0128 | 2006-07-20 |
| 1033143284 | South Mississippi Regional Center | Intermediate Care Facility, Mentally Retarded | 1170 W Railroad St, Long Beach, MS 39560-4106 | 2006-07-11 |
| 1346222163 | Preferred Care Developmental Centers of Ms I Inc | Intermediate Care Facility, Mentally Retarded | 200 Womack St, Starkville, MS 39759-2232 | 2005-11-17 |
| 1174505010 | Preferred Care Developmental Centers of Ms I Inc | Intermediate Care Facility, Mentally Retarded | 524 Brookman Dr, Brookhaven, MS 39601-2384 | 2005-11-16 |
| 1710969787 | Preferred Care Developmental Centers of Ms I, Inc. | Intermediate Care Facility, Mentally Retarded | 701 Highway 322, Clarksdale, MS 38614-4722 | 2005-11-16 |
| 1659353688 | Preferred Care Developmental Centers of Ms I Inc | Intermediate Care Facility, Mentally Retarded | 1145 Tisdale Ave, Canton, MS 39046-4965 | 2005-11-16 |
| 1346234184 | Hudspeth Center Pharmacy | Intermediate Care Facility, Mentally Retarded | Highway 475, Whitfield, MS 39193 | 2005-09-08 |
| 1275901167 | Baptist Homes Inc | Intermediate Care Facility, Mentally Retarded | 461 Goodloe Rd, Canton, MS 39046-9740 | 2015-09-09 |
| Find all providers with the same taxonomy | ||||
| City | ELLISVILLE |
| Zip Code | 39437 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.