Mississippi Adolescent Center

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

MISSISSIPPI ADOLESCENT CENTER

Practice address

760 Brookman Drive Extension
Brookhaven, MS 39601-2340

Phone

(601) 823-5700

Fax

(601) 823-5769

NPI assigned

Feb 16, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Edwin C. Legrand, M.A.

Title

Executive Director, Mississippi Dep

Phone

(601) 359-1288

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 25G019

Legal name

MISSISSIPPI ADOLESCENT CENTER

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Apr 1, 2011

Last certification

Feb 5, 2026

Beds

36

Ownership / control type

State

Facility address

760 Brookman Drive
Brookhaven, MS 39601

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

East Ms State Hospital2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Magnolia Clinic

  • Clinic/Center
  • Meridian, MS
  • NPI 1093038234
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bathsheba Brown

  • Medical-Surgical Registered Nurse
  • Brookhaven, MS
  • NPI 1568930469
  NPD (past)
• William Stanley Hay, M.D.

  • Family Medicine Physician
  • Brookhaven, MS
  • NPI 1881952489
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297814400000",
    "number": "1376840058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 BROOKMAN DRIVE EXTENSION",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012340",
            "telephone_number": "601-823-5700",
            "fax_number": "601-823-5769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 BROOKMAN DRIVE EXTENSION",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012340",
            "telephone_number": "601-823-5700",
            "fax_number": "601-823-5769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI ADOLESCENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-16",
        "last_updated": "2011-02-16",
        "status": "A",
        "authorized_official_last_name": "LEGRAND",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR, MISSISSIPPI DEP",
        "authorized_official_telephone_number": "601-359-1288",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Milestones Pediatric Clinic, LLC
• Christina Ruth Miller, NP
• Richard Eric Miller, M.D.
• Christi Evans Mills, P.T.
• Stephen J Mills, M.D.
• Mississippi Methodist Hospital & Rehabilitation Center, Inc.
• Mississippi Staff Healing PLLC
• Mississippi State Department of Health
• Haley Mitchell, FNP-C
• Dara E Moak, ATC

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Brookhaven, MS
• Providers in Brookhaven, MS by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.