Provider Demographics
NPI:1689283806
Name:GRACIOUS BLESSINGS LLC
Entity Type:Organization
Organization Name:GRACIOUS BLESSINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-600-1069
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:OSYKA
Mailing Address - State:MS
Mailing Address - Zip Code:39657-0581
Mailing Address - Country:US
Mailing Address - Phone:601-600-1069
Mailing Address - Fax:601-600-1069
Practice Address - Street 1:114 3RD STREET
Practice Address - Street 2:
Practice Address - City:OSYKA
Practice Address - State:MS
Practice Address - Zip Code:39657-3965
Practice Address - Country:US
Practice Address - Phone:601-600-1069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty