Provider Demographics
NPI:1659747988
Name:AGING GRACEFULLY COMMUNITY CENTER
Entity Type:Organization
Organization Name:AGING GRACEFULLY COMMUNITY CENTER
Other - Org Name:AGING GRACEFULLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-894-1120
Mailing Address - Street 1:16165 HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-2002
Mailing Address - Country:US
Mailing Address - Phone:601-894-1120
Mailing Address - Fax:844-270-3071
Practice Address - Street 1:16165 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2002
Practice Address - Country:US
Practice Address - Phone:601-894-1120
Practice Address - Fax:844-270-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home