Healthcare Provider Details

I. General information

NPI: 1689283806
Provider Name (Legal Business Name): GRACIOUS BLESSINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 3RD STREET
OSYKA MS
39657-3965
US

IV. Provider business mailing address

PO BOX 581
OSYKA MS
39657-0581
US

V. Phone/Fax

Practice location:
  • Phone: 601-600-1069
  • Fax:
Mailing address:
  • Phone: 601-600-1069
  • Fax: 601-600-1069

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 Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: ARNETTA SIMMONS
Title or Position: MANAGER
Credential:
Phone: 601-600-1069