Healthcare Provider Details

I. General information

NPI: 1710780648
Provider Name (Legal Business Name): GRACEFUL JOURNEYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 06/08/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 OLD HIGHWAY 16
CANTON MS
39046-8788
US

IV. Provider business mailing address

PO BOX 1762
CANTON MS
39046-1762
US

V. Phone/Fax

Practice location:
  • Phone: 601-260-8526
  • Fax:
Mailing address:
  • Phone: 601-260-8526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. CHARLIE C LUCKETT
Title or Position: MANAGER
Credential:
Phone: 601-260-8526