NPIMap

Organization Active NPI

Ellisville State School

  • Intellectual Disabilities Intermediate Care Facility
  • Ellisville, MS
National Provider Identifier
1285947408
Registry record updated Jan 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
ELLISVILLE STATE SCHOOL
Practice address
1101 Hwy 11 S
Ellisville, MS 39437-4443
Phone
(601) 477-5607
Fax
(601) 477-5700
NPI assigned
Jul 16, 2010
Last updated
Jan 27, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Rene'E Brett
Title
Director
Phone
(601) 477-5595

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

1101 Hwy 11 S
Ellisville, MS 39437-4443

Mailing address

1101 Hwy 11 S
Ellisville, MS 39437-4443
Phone (601) 477-5607

Other identifiers 1

IdentifierTypeStateIssuer
05850722MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Ellisville State School9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296086400000",
    "number": "1285947408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 HWY 11 S",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "394374443",
            "telephone_number": "601-477-5607",
            "fax_number": "601-477-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 HWY 11 S",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "394374443",
            "telephone_number": "601-477-5607",
            "fax_number": "601-477-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLISVILLE STATE SCHOOL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-16",
        "last_updated": "2011-01-27",
        "status": "A",
        "authorized_official_last_name": "BRETT",
        "authorized_official_first_name": "RENE'E",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-477-5595",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05850722",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellisville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.