Provider Demographics
NPI:1942429899
Name:GRACE HOME HEATLH AGENCY
Entity type:Organization
Organization Name:GRACE HOME HEATLH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EARLEEN
Authorized Official - Middle Name:SURALL
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:REV
Authorized Official - Phone:662-492-0883
Mailing Address - Street 1:550 COMMERCE ST APT 14
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-3052
Mailing Address - Country:US
Mailing Address - Phone:662-494-5890
Mailing Address - Fax:
Practice Address - Street 1:550 COMMERCE ST APT 14
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-3052
Practice Address - Country:US
Practice Address - Phone:662-494-5890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAO9357251E00000X
MS347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered347C00000XTransportation ServicesPrivate Vehicle