# ELLISVILLE STATE SCHOOL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568468080
- **Authorized official:** DR. SUZIE LASSITER (DIRECTOR)
- **Authorized official phone:** (601) 477-9384

## Contact information

- **Practice address:** 1101 HWY 11 S, ELLISVILLE, MS 39437-4444
- **Practice address phone:** (601) 477-9384
- **Practice address fax:** (601) 477-5700
- **Mailing address:** 1101 HWY 11 S, ELLISVILLE, MS 39437-4444
- **Mailing address phone:** (601) 477-9384
- **Mailing address fax:** (601) 477-5700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | C00638 | MS | Yes |

## Other

- **Enumeration date:** 06/21/2005
- **Last updated:** 08/22/2020