Pecan Grove

LBN: Pecan Grove
Pecan Grove is an health care organization with primary practice located at 1101 Highway 11 S , Ellisville MS 39437-4443. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility, which is considered as the primary health care specialty. Pecan Grove can be contacted via phone (601) 477-9384, or through Lassiter, Suzie via phone (601) 477-9384.

Contact Information

Primary practice address
1101 Highway 11 S Ellisville MS 39437-4443
Phone: (601) 477-9384
Fax: (601) 477-5700
Website:
Map and Directions
Authorized official contact:
Name: Lassiter, Suzie
Phone: (601) 477-9384

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility 313M00000X 284 Mississippi

Profile Details

NPI number 1205904604
LBN Legal business name Pecan Grove
DBA Doing business as
Authorized official Lassiter, Suzie
Entity Organization
Organization subpart 1 No
Enumeration date Dec 1st, 2006
Last updated Aug 22nd, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205904604 NPPES
Mississippi MEDICAID 00021847

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