Healthcare Provider Details

I. General information

NPI: 1902121809
Provider Name (Legal Business Name): GRACE HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SLATER STREET
VALDOSTA GA
31601
US

IV. Provider business mailing address

1010 SLATER STREET
VALDOSTA GA
31601
US

V. Phone/Fax

Practice location:
  • Phone: 229-469-4052
  • Fax: 229-588-4039
Mailing address:
  • Phone: 229-469-4052
  • Fax: 229-588-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number372083530A
License Number StateGA

VIII. Authorized Official

Name: MS. CYNTHIA E MCDOUGLE
Title or Position: CEO
Credential:
Phone: 229-269-8880