Organization · Type 2 NPI

Pecan Grove

Nursing Facility/Intermediate Care Facility · Ellisville, MS

NPI number 1205904604 Active

Practice location

1101 Highway 11 S
Ellisville, MS 39437-4443

Fax (601) 477-5700

Specialties and licenses

Taxonomy	Code	License
Nursing Facility/Intermediate Care Facility Primary	313M00000X	284 (MS)

Nursing Facility/Intermediate Care Facility: An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical conditi…

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About NPI 1205904604

Pecan Grove's National Provider Identifier is 1205904604, issued on Dec 1, 2006. The primary taxonomy on file is Nursing Facility/Intermediate Care Facility (313M00000X), and the practice location is in Ellisville, MS. The record was last updated on Aug 22, 2020.