=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588175111
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACE FOR TODAY HOMECARE AGENCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2017
-----------------------------------------------------
Last Update Date | 06/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203 S MAIN ST
-----------------------------------------------------
City | SARDIS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38666-1724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 622-301-2003
-----------------------------------------------------
Fax | 662-857-2065
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 343
-----------------------------------------------------
City | SARDIS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38666-0343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-267-9673
-----------------------------------------------------
Fax | 662-712-6040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. DENISE CORBETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-267-9673
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------