National Provider Identifier Database

REGION 12 COMMISSION ON MENTAL HEALTH AND RETARDATION
Substance Abuse Disorder Rehabilitation Facility

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.


Contact Information

REGION 12 COMMISSION ON MENTAL HEALTH AND RETARDATION
3 CLEARVIEW CIR
MOSELLE, MS39459-9520
Phone: 601-544-1499
Fax: 601-584-4053
Website:
Specialty Taxonomy Code
* Substance Abuse Disorder Rehabilitation Facility 324500000X

* Indicates primary specialty

NPI Profile & details for REGION 12 COMMISSION ON MENTAL HEALTH AND RETARDATION

NPI Number 1982612206
Legal business name
LBN
REGION 12 COMMISSION ON MENTAL HEALTH AND RETARDATION
Authorized official JANET MAYS - (CHIEF FINACIAL OFFICER)
Entity Organization
Organization subpart No
Enumeration date 08/03/2006
Last updated 08/22/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • MS License #: R12-DADA-PR-TR-OP-01
  • MS Medicaid: 00018212
  • MS Other: 20463 BC/BS PROVIDER NUMBER

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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