Healthcare Provider Details

I. General information

NPI: 1891484671
Provider Name (Legal Business Name): GOD'S GRACE MEDICAL STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9110 GEYER SPRINGS RD
LITTLE ROCK AR
72209-6425
US

IV. Provider business mailing address

9110 GEYER SPRINGS RD
LITTLE ROCK AR
72209-6425
US

V. Phone/Fax

Practice location:
  • Phone: 501-443-3170
  • Fax:
Mailing address:
  • Phone: 501-443-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROLYN JEFFERSON
Title or Position: OWNER
Credential: RN, BSN
Phone: 501-349-7827