OrganizationActive
Ellisville State School
NPI 1811135718 · Intellectual Disabilities Intermediate Care Facility · Ellisville, MS
Provider details
- NPI number
- 1811135718
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Stephanie Smith, Family Nurse Practitioner(601) 477-5770
- License
- R865285 (MS)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Detailed profile(86/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
17 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1101 Hwy 11 S
Ellisville, MS 39437-4443
Phone: (601) 477-5770
Fax: (601) 477-5895
Approximate (ZIP-level) locationGet directions
Mailing address
1101 Hwy 11 S
Ellisville, MS 39437-4443
Registry dates
- Enumerated
- 2009-01-30
- Last updated
- 2009-01-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.