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General NPI Number Information
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NPI Number | 1508575895
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Entity Type | Organization
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Legal Business Name | GRACE COVENANT SERVICES, LLC
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Dates
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Enumeration Date | 11/16/2022
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 1600 E REED RD
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City | GREENVILLE
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State | MS
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Zip | 38703-7229
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Country | US
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Telephone | 662-580-0653
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Fax | 662-580-0569
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Provider Business Mailing Address
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Address Line | 1600 E REED RD
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City | GREENVILLE
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State | MS
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Zip | 38703-7229
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Country | US
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Telephone | 662-580-0653
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Fax | 662-580-0569
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JENNIFER JOHNSON
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Credential | REGISTERED NURSE
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Telephone | 662-580-0635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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