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General NPI Number Information
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NPI Number | 1942429899
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Entity Type | Organization
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Legal Business Name | GRACE HOME HEATLH AGENCY
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 550 COMMERCE ST APT 14
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City | WEST POINT
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State | MS
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Zip | 39773-3052
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Country | US
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Telephone | 662-494-5890
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Fax |
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Provider Business Mailing Address
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Address Line | 550 COMMERCE ST APT 14
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City | WEST POINT
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State | MS
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Zip | 39773-3052
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Country | US
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Telephone | 662-494-5890
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. EARLEEN SURALL YOUNG
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Credential | REV
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Telephone | 662-492-0883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | AO9357
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License Number State | MS
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Taxonomy #2
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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 | MS
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