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NPI Provider: 1568468080
Contact Name: Lassiter Suzie
Position: Director
Phone: (601) 477-9384
Ellisville State School Information:
Ellisville State School organization have npi 1568468080, taxonomy code is 261Q00000X with license number is C00638 in . This Business address located in 1101 HWY 11 S, Ellisville, MS 39437 Mississippi. Get directions of Ellisville State School.
Practice Location
Address: 1101 HWY 11 S, Ellisville, MS 39437
Phone: (601) 477-9384
Business Location
Address: 1101 HWY 11 S, Ellisville, MS 39437
Phone: (601) 477-9384
Fax: (601) 477-5700
Taxonomy
Taxonomy Code: 261Q00000X
License Number: C00638
License Number of State: MS
Primary Taxonomy Switch: Y
Enumeration Date: 6/21/2005
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