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Pecan Grove
Nursing Facility/Intermediate Care Facility in Ellisville, Mississippi
NPI 1205904604

Pecan Grove is a Nursing Facility/Intermediate Care Facility based in Ellisville, MS. Pecan Grove practices in Ellisville, MS. The NPI Number for Pecan Grove is 1205904604 and holds a License No. 284 (Mississippi).

The current practice location address for Pecan Grove is 1101 Highway 11 S, Ellisville, MS and can be reached out via phone at 601-477-9384 and via fax at 601-477-5700.

Location: 1101 Highway 11 S, Ellisville, MS, 39437-4443
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1205904604
Provider Name
Pecan Grove
Credential
Provider Entity Type
Organization
Address
1101 Highway 11 S, Ellisville, MS, 39437-4443
Phone Number
601-477-9384
Fax Number
601-477-5700
Provider Enumeration Date
12/01/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
00021847 05 MS
institution
Provider Business Practice Location Address Details
Address
1101 Highway 11 S
City
Ellisville
State
Mississippi
Zip
39437-4443
Phone Number
601-477-9384
Fax Number
601-477-5700
person
Provider Business Mailing Address Details
Address
1101 Highway 11 S
City
Ellisville
State
Mississippi
Zip
39437-4443
Phone Number
601-477-9384
Fax Number
601-477-5700
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Nursing Facility/Intermediate Care Facility
Speciality
-
Taxonomy
313M00000X
License No.
284 (Mississippi)
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 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.
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NPI 1306914700
Nursing Facility/Intermediate Care Facility
1101 Highway 11 S,
ELLISVILLE, MS
39437-4443
601-477-9384
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