Healthcare Provider Details

I. General information

NPI: 1548533862
Provider Name (Legal Business Name): GRACIOUS SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 WINCHESTER CIR
MONROE LA
71203-6625
US

IV. Provider business mailing address

28 WINCHESTER CIR
MONROE LA
71203-6625
US

V. Phone/Fax

Practice location:
  • Phone: 318-547-3909
  • Fax:
Mailing address:
  • Phone: 318-547-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ROYMELLE MASON
Title or Position: EXECUTIVE DIRECTOR
Credential: RN.,BSN
Phone: 318-547-3909