Healthcare Provider Details

I. General information

NPI: 1588182182
Provider Name (Legal Business Name): GRACE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2017
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 PENNSYLVANIA AVE
MCCOMB MS
39648-4744
US

IV. Provider business mailing address

PO BOX 911
MCCOMB MS
39649-0911
US

V. Phone/Fax

Practice location:
  • Phone: 601-684-8089
  • Fax: 601-873-1649
Mailing address:
  • Phone: 601-684-8089
  • Fax: 601-873-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SHEILA WILLIAMS BARNES
Title or Position: OWNER
Credential:
Phone: 601-684-8089