Healthcare Provider Details

I. General information

NPI: 1144670704
Provider Name (Legal Business Name): GRACEY & MURPHY FAITHFUL CODE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 RIDGEWOOD PL SUITE G
JACKSON MS
39211-2002
US

IV. Provider business mailing address

1058 RIDGEWOOD PL SUITE G
JACKSON MS
39211-2002
US

V. Phone/Fax

Practice location:
  • Phone: 601-809-9222
  • Fax:
Mailing address:
  • Phone: 601-809-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number326285
License Number StateMS

VIII. Authorized Official

Name: MRS. MANERIVA ANN LEE
Title or Position: CASE MANGER
Credential:
Phone: 601-809-8684