Healthcare Provider Details

I. General information

NPI: 1730916743
Provider Name (Legal Business Name): GRACEFUL CARE CASE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 FOXBOROUGH LN
BONAIRE GA
31005-3665
US

IV. Provider business mailing address

801A PARK DR UNIT 107
WARNER ROBINS GA
31088-5174
US

V. Phone/Fax

Practice location:
  • Phone: 229-202-7234
  • Fax: 888-765-7033
Mailing address:
  • Phone: 229-202-7234
  • Fax: 888-765-7033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: TIFFANI BROWN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RN
Phone: 229-202-7234