Organization
ELLISVILLE STATE SCHOOL
Active
Other names
Clover Circle ICF/MR
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAM K YOUNG (ACCOUNTING AUDITOR 1)
(601) 477-5606
Entity
Organization
Contact information
Practice address
1101 HIGHWAY 11 S, ELLISVILLE, MS 39437-4443
(601) 477-9384
(601) 477-5700
Mailing address
1101 HIGHWAY 11 S, ELLISVILLE, MS 39437-4443
(601) 477-9384
(601) 477-5700
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
233
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00021831
—
MS
Enumeration date
09/07/2006
Last updated
06/12/2008
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