Healthcare Provider Details

I. General information

NPI: 1730003732
Provider Name (Legal Business Name): HEART OF GRACE SENIOR TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W MAIN ST
FOREST MS
39074-4154
US

IV. Provider business mailing address

231 W MAIN ST
FOREST MS
39074-4154
US

V. Phone/Fax

Practice location:
  • Phone: 601-837-6858
  • Fax: 601-287-8230
Mailing address:
  • Phone: 601-837-6858
  • Fax: 601-287-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: TAMEKA WOOTEN
Title or Position: DIRECTOR
Credential:
Phone: 601-837-6858