Provider Demographics
NPI:1245896380
Name:GRACE SITTER SERVICE
Entity type:Organization
Organization Name:GRACE SITTER SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:BALLENTINE
Authorized Official - Last Name:CREEKMORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:662-360-8138
Mailing Address - Street 1:634 DEER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-7683
Mailing Address - Country:US
Mailing Address - Phone:662-360-8138
Mailing Address - Fax:
Practice Address - Street 1:634 DEER CREEK RD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-7683
Practice Address - Country:US
Practice Address - Phone:662-360-8138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care