Organization
NORTHEAST MENTAL HEALTH-MENTAL RETARDATION COMMISSION
Active
Other names
LIFECORE HEALTH GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN STALL (CFO)
(662) 844-1717
Entity
Organization
Contact information
Practice address
2434 S EASON BLVD, TUPELO, MS 38804-6942
(662) 844-1717
(662) 680-6416
Mailing address
2434 S EASON BLVD, TUPELO, MS 38804-6942
(662) 844-1717
(662) 680-6416
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04329807
—
MS
05
—
07453596
—
MS
Enumeration date
11/03/2008
Last updated
03/20/2014
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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