Healthcare Provider Details

I. General information

NPI: 1144124769
Provider Name (Legal Business Name): GRATEFUL ASSISTANCE HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 PENNSYLVANIA AVE
MCCOMB MS
39648-4744
US

IV. Provider business mailing address

815 PENNSYLVANIA AVE STE A
MCCOMB MS
39648-4744
US

V. Phone/Fax

Practice location:
  • Phone: 601-265-8418
  • Fax:
Mailing address:
  • Phone: 601-265-8418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: TANALSHA WILLIAMS
Title or Position: OWNER
Credential:
Phone: 601-265-8418