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LIFECORE HEALTH GROUP
NPI 1548413628
Clinic/Center - Rural Health in Tupelo, MS

Active since November 03, 2008CLIA Certified · 2 labs
2434 S EASON BLVD, TUPELO, MS 38804(662) 844-1717(662) 680-6416 Get Directions Write a Review

NPPES record last updated: March 20, 2014. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Lifecore Health Group NPPES

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

LIFECORE HEALTH GROUP (NPI 1548413628) is a healthcare organization registered as a rural health in Tupelo, Mississippi and active in the NPI registry since November 2008. The organization holds 2 active CLIA laboratory certificates and lists Steven Stall, Cfo, as its authorized official.

NPPES Registry Identity

NPI1548413628
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameNORTHEAST MENTAL HEALTH-MENTAL RETARDATION COMMISSION
Location Address2434 S EASON BLVDTupelo, MS 38804-6942
Mailing Address2434 S Eason BlvdTupelo, MS 38804-6942 · (662) 844-1717 · Fax (662) 680-6416
Phone(662) 844-1717
Fax(662) 680-6416
Organization SubpartNo
Authorized OfficialSteven StallCfo · (662) 844-1717
Enumeration DateNovember 3, 2008
Last NPPES UpdateMarch 20, 2014
✔ NPI 1548413628 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
Also ListedClinic/Center · Multi-SpecialtyTaxonomy 261QM1300X
2434 S EASON BLVD, Tupelo, MS 38804
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Other Names 1

Doing Business AsLifecore Health Group

Other Identifiers 4

Medicaid04329807MS
Medicare OSCAR/certification253850
Medicaid07453596MS
Medicare PIN512G700501

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

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 25D2160506

Lifecore Health Group · Tupelo, MS
Active · expires Jan 10, 2027
CLIA Number25D2160506
Laboratory TypeRural Health Clinic
Certificate Effective DateJanuary 11, 2025
Certificate Expiration DateJanuary 10, 2027
Laboratory DirectorRita Berthay
Laboratory Phone(662) 594-2023
Laboratory LocationLifecore Health Group1927 A Briar Ridge Rd, Tupelo, MS 38804
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 25D2155250

Lifecore Health Group · Tupelo, MS
Active · expires Sep 25, 2026
CLIA Number25D2155250
Laboratory TypeRural Health Clinic
Certificate Effective DateSeptember 26, 2024
Certificate Expiration DateSeptember 25, 2026
Laboratory DirectorRita Berthay
Laboratory Phone(662) 388-5465
Laboratory LocationLifecore Health Group1927B Briar Ridge Road, Tupelo, MS 38804
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. DEBRA ANN WARD
Counselor (Mental Health)
2434 S EASON BLVD
TUPELO, MS 38804
Lee County (662) 844-1717
MRS. MICHELLE FREED BIRMINGHAM
Counselor (Mental Health)
2434 S EASON BLVD
TUPELO, MS 38804
Lee County (662) 844-1717
MISS JESSICA OWEN LONG BS
Counselor (Mental Health)
2434 S EASON BLVD
TUPELO, MS 38804
Lee County (662) 844-1717
MS. SHIRLEY JEAN BOWERS LSW, BA
Counselor (Mental Health)
2434 S EASON BLVD
TUPELO, MS 38804
Lee County (662) 844-1717
MR. ROBERT SAMUEL BURRESS BA, CM
Counselor (Mental Health)
2434 S EASON BLVD
TUPELO, MS 38804
Lee County (662) 844-1717
MS. LISA M EVANS BA
Counselor (Mental Health)
2434 S EASON BLVD
TUPELO, MS 38804
Lee County (662) 844-1717
MRS. QUANASHETIA MCKINNEY IVY BSW
Counselor (Mental Health)
2434 S EASON BLVD
TUPELO, MS 38804
Lee County (662) 844-1717
MRS. LOIS ANN COX LMSW
Social Worker (Clinical)
2434 S EASON BLVD
TUPELO, MS 38804
Lee County (662) 844-1717

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 Northeast Mental Health-Mental Retardation Commission's NPI number?

The NPI number for Northeast Mental Health-Mental Retardation Commission is 1548413628. It was assigned to this organization in the NPPES registry on November 3, 2008. The provider is doing business as Lifecore Health Group.

Where is Northeast Mental Health-Mental Retardation Commission located?

Northeast Mental Health-Mental Retardation Commission is located at 2434 S Eason Blvd, Tupelo, MS 38804. The listed phone number is (662) 844-1717.

What is Northeast Mental Health-Mental Retardation Commission's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

Does Northeast Mental Health-Mental Retardation Commission hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Northeast Mental Health-Mental Retardation Commission accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of Tennessee and 1 other insurer list Northeast Mental Health-Mental Retardation Commission as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Northeast Mental Health-Mental Retardation Commission was last updated on March 20, 2014. NPI Profile syncs with the weekly NPPES data releases published by CMS.