NORTHEAST MENTAL HEALTH-MENTAL RETARDATION COMMISSION NPI 1679903546

NPI Information

NORTHEAST MENTAL HEALTH-MENTAL RETARDATION COMMISSION is a rural health clinic center in Tupelo, MS. NORTHEAST MENTAL HEALTH-MENTAL RETARDATION COMMISSION NPI is 1679903546. The provider is registered as an organization entity type.
The provider Is Doing Business As Lifecore Health Group.

The provider's business location address is:

499 GLOSTER CREEK VLG
SUITE A-3
TUPELO, MS
ZIP 38801-600
Phone: (662) 844-1717
Fax: (662) 680-6416

The provider's authorized official is Rita Berthay .
The authorized official title is Ceo and has the following contact phone number (662) 640-4595.

The CLIA number assigned to this NPI record is 25D2155250 - rural health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/13/2013 and was last updated on 2/27/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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