PECAN GROVE
NPI 1205904604
Nursing Facility/Intermediate Care Facility in Ellisville, MS

Q: What is Pecan Grove's NPI number?

The NPI number for Pecan Grove is 1205904604. It was assigned to this organization in the NPPES registry on December 1, 2006.

Q: What is Pecan Grove's specialty?

The primary specialty registered for this NPI is Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.

Q: When was this NPI record last updated?

The NPPES record for Pecan Grove was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 01, 2006

1101 HIGHWAY 11 S, ELLISVILLE, MS 39437(601) 477-9384(601) 477-5700 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Pecan Grove NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PECAN GROVE (NPI 1205904604) is a healthcare organization registered as a nursing facility/intermediate care facility in Ellisville, Mississippi and active in the NPI registry since December 2006. The organization lists Suzie Lassiter, Director Of Facility, as its authorized official.

NPPES Registry Identity

NPI1205904604

Entity TypeOrganization

Primary Taxonomy313M00000X

Legal Business NamePECAN GROVE

Location Address1101 HIGHWAY 11 SEllisville, MS 39437-4443

Mailing Address1101 Highway 11 SEllisville, MS 39437-4443 · (601) 477-9384 · Fax (601) 477-5700

Phone(601) 477-9384

Fax(601) 477-5700

Organization SubpartNo

Authorized OfficialSuzie LassiterDirector Of Facility · (601) 477-9384

Enumeration DateDecember 1, 2006

Last NPPES UpdateAugust 22, 2020

✔ NPI 1205904604 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities

Taxonomy Code313M00000X

License✔ Licensed in MS · 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 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.

1101 HIGHWAY 11 S, Ellisville, MS 39437

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Other Identifiers 1

Medicaid00021847MS

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ELLISVILLE STATE SCHOOL DENTAL

Dentist