Organization
NORTHEAST MENTAL HEALTH-MENTAL RETARDATION COMMISSION
Active
Other names
Lifecore Health Group
Organization subpart
No
Provider details
NPI number
Authorized official
RITA BERTHAY (CEO)
(662) 640-4595
Entity
Organization
Contact information
Practice address
499 GLOSTER CREEK VLG, SUITE A-3, TUPELO, MS 38801-4600
(662) 844-1717
(662) 680-6416
Mailing address
2434 S EASON BLVD, TUPELO, MS 38804-6942
(662) 640-4595
(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
—
000
—
MS
01
—
0000
BLUE CROSS
MS
05
—
0000000
—
MS
Enumeration date
11/13/2013
Last updated
02/27/2020
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