Provider Demographics
NPI:1194455071
Name:GRACEFULLY AGING SENIOR SERVICES, INC
Entity Type:Organization
Organization Name:GRACEFULLY AGING SENIOR SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-425-1122
Mailing Address - Street 1:306 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MS
Mailing Address - Zip Code:39730-3214
Mailing Address - Country:US
Mailing Address - Phone:662-318-6222
Mailing Address - Fax:662-368-1635
Practice Address - Street 1:306 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-3214
Practice Address - Country:US
Practice Address - Phone:662-318-6222
Practice Address - Fax:662-368-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care