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General NPI Number Information
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NPI Number | 1659747988
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Entity Type | Organization
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Legal Business Name | AGING GRACEFULLY COMMUNITY CENTER
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | 16165 HIGHWAY 51
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City | HAZLEHURST
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State | MS
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Zip | 39083-2002
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Country | US
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Telephone | 601-894-1120
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Fax | 844-270-3071
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Provider Business Mailing Address
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Address Line | 16165 HIGHWAY 51
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City | HAZLEHURST
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State | MS
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Zip | 39083-2002
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Country | US
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Telephone | 601-894-1120
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Fax | 844-270-3071
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CAROL NEWTON
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Credential |
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Telephone | 601-894-1120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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