Healthcare Provider Details

I. General information

NPI: 1104033224
Provider Name (Legal Business Name): GRANDCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30627 HIGHWAY 8 E
GRENADA MS
38901-7902
US

IV. Provider business mailing address

30627 HIGHWAY 8 E
GRENADA MS
38901-7902
US

V. Phone/Fax

Practice location:
  • Phone: 662-809-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MR. RONALD O RESPESS SR.
Title or Position: OWNER
Credential:
Phone: 662-809-2727