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General NPI Number Information
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NPI Number | 1790835635
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Entity Type | Organization
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Legal Business Name | GRACE AND MERCY PERSONAL CARE AND RESPITE SERVICE, LLC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 410 MASONIC DRIVE
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City | CLINTON
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State | MS
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Zip | 39056
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Country | US
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Telephone | 601-488-4027
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Fax | 601-488-4128
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Provider Business Mailing Address
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Address Line | PO BOX 374
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City | CLINTON
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State | MS
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Zip | 39060
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Country | US
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Telephone | 601-488-4027
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Fax | 601-488-4128
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SYLVIAETTE HARRIS
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Credential |
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Telephone | 601-488-4027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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