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General NPI Number Information
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NPI Number | 1710780648
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Entity Type | Organization
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Legal Business Name | GRACEFUL JOURNEYS LLC
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 06/08/2025
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Provider Practice Location Address
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Address Line | 120 OLD HIGHWAY 16
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City | CANTON
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State | MS
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Zip | 39046-8788
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Country | US
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Telephone | 601-260-8526
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1762
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City | CANTON
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State | MS
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Zip | 39046-1762
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Country | US
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Telephone | 601-260-8526
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. CHARLIE C LUCKETT
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Credential |
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Telephone | 601-260-8526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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