Healthcare Provider Details

I. General information

NPI: 1891024642
Provider Name (Legal Business Name): GRACE HEALTH & REHAB OF GRENADA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1966 HILL DR
GRENADA MS
38901-5047
US

IV. Provider business mailing address

1966 HILL DR
GRENADA MS
38901-5047
US

V. Phone/Fax

Practice location:
  • Phone: 662-226-2442
  • Fax: 662-226-9567
Mailing address:
  • Phone: 662-226-2442
  • Fax: 662-226-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ADRIENNE J MURPHY
Title or Position: VICE PRESIDENT
Credential:
Phone: 901-937-7994