MISSISSIPPI ADOLESCENT CENTER
NPI 1376840058
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Brookhaven, MS

Q: What is Mississippi Adolescent Center's NPI number?

The NPI number for Mississippi Adolescent Center is 1376840058. It was assigned to this organization in the NPPES registry on February 16, 2011.

Q: What is Mississippi Adolescent Center's specialty?

The primary specialty registered for this NPI is Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320600000X.

Active since February 16, 2011CLIA 25D1043490 · Waiver

760 BROOKMAN DRIVE EXTENSION, BROOKHAVEN, MS 39601(601) 823-5700(601) 823-5769 Get Directions Write a Review

NPPES record last updated: February 16, 2011. Verified against the NPPES registry weekly; last sync: August 30, 2026.

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About Mississippi Adolescent Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISSISSIPPI ADOLESCENT CENTER (NPI 1376840058) is a healthcare organization registered as a residential treatment facility, intellectual and/or developmental disabilities in Brookhaven, Mississippi and active in the NPI registry since February 2011. The organization holds a CLIA Waiver certificate valid through July 25, 2027 and lists Edwin C. Legrand, Executive Director, Mississippi Dep, as its authorized official.

NPPES Registry Identity

NPI1376840058

Entity TypeOrganization

Primary Taxonomy320600000X

Legal Business NameMISSISSIPPI ADOLESCENT CENTER

Location Address760 BROOKMAN DRIVE EXTENSIONBrookhaven, MS 39601-2340

Mailing Address760 Brookman Drive ExtensionBrookhaven, MS 39601-2340 · (601) 823-5700 · Fax (601) 823-5769

Phone(601) 823-5700

Fax(601) 823-5769

Organization SubpartNo

Authorized OfficialEdwin C. LegrandExecutive Director, Mississippi Dep · (601) 359-1288

Enumeration DateFebruary 16, 2011

✔ NPI 1376840058 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities

Taxonomy Code320600000X

Definition

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

760 BROOKMAN DRIVE EXTENSION, Brookhaven, MS 39601

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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D1043490

Mississippi Adolescent Center · Brookhaven, MS

Active · expires Jul 25, 2027

CLIA Number25D1043490

Laboratory TypeIntermediate Care Facility For Mentally Retarded

Certificate Effective DateJuly 26, 2025

Certificate Expiration DateJuly 25, 2027

Laboratory DirectorClint Ashley

Laboratory Phone(601) 823-5700

Laboratory LocationMississippi Adolescent Center760 Brookman Drive, Brookhaven, MS 39601

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mississippi Adolescent Center's NPI number?

The NPI number for Mississippi Adolescent Center is 1376840058. It was assigned to this organization in the NPPES registry on February 16, 2011.

Where is Mississippi Adolescent Center located?

Mississippi Adolescent Center is located at 760 Brookman Drive Extension, Brookhaven, MS 39601. The listed phone number is (601) 823-5700.

What is Mississippi Adolescent Center's specialty?

The primary specialty registered for this NPI is Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320600000X.

Does Mississippi Adolescent Center hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D1043490) is associated with this NPI, valid through July 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mississippi Adolescent Center was last updated on February 16, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.