Organization
ELLISVILLE STATE SCHOOL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE D. SMITH (FAMILY NURSE PRACTITIONER)
(601) 477-5770
Entity
Organization
Contact information
Practice address
1101 HWY 11 S, ELLISVILLE, MS 39437-4443
(601) 477-5770
(601) 477-5895
Mailing address
1101 HWY 11 S, ELLISVILLE, MS 39437-4443
(601) 477-5770
(601) 477-5895
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
R865285
MS
Other
Enumeration date
01/30/2009
Last updated
01/30/2009
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