MISSISSIPPI ADOLESCENT CENTER (NPI# 1376840058) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376840058 |
| Entity Type | Organization |
| Organization Name | MISSISSIPPI ADOLESCENT CENTER |
| Practice Address |
760 Brookman Drive Extension Brookhaven MS 39601-2340 |
| Practice Telephone | 6018235700 |
| Practice Fax Number | 6018235769 |
| Mailing Telephone | 6018235700 |
| Mailing Fax Number | 6018235769 |
| Enumeration Date | 2011-02-16 |
| Last Update Date | 2011-02-16 |
| Authorized Official Name | MR. EDWIN C. LEGRAND (EXECUTIVE DIRECTOR, MISSISSIPPI DEP) |
| Authorized Official Telephone | 6013591288 |
| Authorized Official Credential | M.A. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Street Address |
760 BROOKMAN DRIVE EXTENSION |
| City | BROOKHAVEN |
| State | MS |
| Zip Code | 39601-2340 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093329633 | Mary Lindsey Lumley | Nurse Practitioner | 620 Hwy 51, Brookhaven, MS 39601 | 2020-09-01 |
| 1306371687 | Rocky Mountain Holdings, LLC | Ambulance | 411 Highway 51 N, Brookhaven, MS 39601 | 2017-04-25 |
| 1043759269 | Candace C Turner | Counselor | 860 E River Pl Suite 100, Jackson, MS 39601 | 2017-02-21 |
| 1619419694 | Therapy Nook PC | Speech-Language Pathologist | 520 Schwem Avenue, Brookhaven, MS 39601 | 2016-11-08 |
| 1851742639 | Melanie Smith | Specialist/Technologist | 325 Low Water Lane, Brookhaven, MS 39601 | 2016-06-23 |
| 1134597107 | Passionate Care Home Health,llc | Home Health | 537 St Charles Places, Brookhaven, MS 39601 | 2015-09-09 |
| 1205218690 | Nurse Practitioner Professionals, Pllc | Clinic/Center | 427 Highway 51 Se, Kings Daughters Medical Center-wound Healing Center, Brookhaven, MS 39601 | 2015-06-23 |
| 1043639289 | Joseph S Moak Jr Md Pa | Internal Medicine | 1040 Biglane Drive, Brookhaven, MS 39601 | 2014-04-15 |
| 1902239197 | Melanie Hammill Bishop | Pharmacist | 427 Ms Highway 51 North, Brookhaven, MS 39601 | 2013-08-12 |
| 1386930113 | Hospice Advantage, LLC. | Hospice Care, Community Based | 120 W Cherokee St, Brookhaven, MS 39601 | 2011-06-20 |
| Find all providers in zip 39601 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336507284 | Lapearls Residential and Private Care Facility | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2634 E Lake Blvd Apt 9-9, Robinsonville, MS 38664-8916 | 2016-02-07 |
| 1912383779 | Mississippi Health Services, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 100 W Amite St, Jackson, MS 39201-1203 | 2015-08-04 |
| 1053742684 | Building Futures, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 220 Mcdowell Park Cir, Jackson, MS 39204-4317 | 2013-12-08 |
| 1649552829 | Miles Cororation | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3959 Highway 468 W, Pearl, MS 39208-9001 | 2011-09-14 |
| 1437453057 | Alexander Milne Home for Women | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 616 East 19th Street, Laurel, MS 39440 | 2010-12-23 |
| 1346329935 | Boswell Regional Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Simpson Old Hwy 49 North, Magee, MS 39111-0128 | 2006-11-03 |
| 1831680792 | Gulf Gardens Residential and Community Living LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 460 Briarwood Dr Ste 400, Jackson, MS 39206-3062 | 2018-05-25 |
| 1932525714 | Majestic Estates LLC. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 511 N Broad St, Forest, MS 39074-3511 | 2014-03-17 |
| 1023367455 | Lucy B Hodges Rn Fpnp Pllc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1303 River Rd, Greenwood, MS 38930-4029 | 2012-08-30 |
| City | BROOKHAVEN |
| Zip Code | 39601 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.