Healthcare Provider Details

I. General information

NPI: 1194455071
Provider Name (Legal Business Name): GRACEFULLY AGING SENIOR SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S MAPLE ST
ABERDEEN MS
39730-3214
US

IV. Provider business mailing address

306 S MAPLE ST
ABERDEEN MS
39730-3214
US

V. Phone/Fax

Practice location:
  • Phone: 662-318-6222
  • Fax: 662-368-1635
Mailing address:
  • Phone: 662-318-6222
  • Fax: 662-368-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YVONNE YVONNE RICHARD
Title or Position: CEO
Credential:
Phone: 662-425-1122