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General NPI Number Information
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NPI Number | 1982356069
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Entity Type | Organization
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Legal Business Name | GRACE MOBILE CARE
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Dates
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Enumeration Date | 01/20/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 855 S PEAR ORCHARD RD STE 305
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City | RIDGELAND
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State | MS
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Zip | 39157-5114
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Country | US
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Telephone | 769-300-0084
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Fax | 601-707-5486
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Provider Business Mailing Address
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Address Line | 855 S PEAR ORCHARD RD STE 305
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City | RIDGELAND
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State | MS
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Zip | 39157-5114
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Country | US
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Telephone | 769-300-0084
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Fax | 601-707-5486
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Authorized Official
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Title or Position | OWNER
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Name | SHUNTELL THOMPSON
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Credential |
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Telephone | 601-913-0332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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