Provider Demographics
NPI:1548533862
Name:GRACIOUS SERVICES, INC
Entity type:Organization
Organization Name:GRACIOUS SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROYMELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:318-547-3909
Mailing Address - Street 1:28 WINCHESTER CIR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-6625
Mailing Address - Country:US
Mailing Address - Phone:318-547-3909
Mailing Address - Fax:
Practice Address - Street 1:28 WINCHESTER CIR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-6625
Practice Address - Country:US
Practice Address - Phone:318-547-3909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care