Organization
MISSISSIPPI ADOLESCENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWIN C. LEGRAND M.A. (EXECUTIVE DIRECTOR, MISSISSIPPI DEP)
(601) 359-1288
Entity
Organization
Contact information
Practice address
760 BROOKMAN DRIVE EXTENSION, BROOKHAVEN, MS 39601-2340
(601) 823-5700
(601) 823-5769
Mailing address
760 BROOKMAN DRIVE EXTENSION, BROOKHAVEN, MS 39601-2340
(601) 823-5700
(601) 823-5769
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/16/2011
Last updated
02/16/2011
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