Provider Demographics
NPI:1982356069
Name:GRACE MOBILE CARE
Entity Type:Organization
Organization Name:GRACE MOBILE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHUNTELL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-913-0332
Mailing Address - Street 1:855 S PEAR ORCHARD RD STE 305
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5114
Mailing Address - Country:US
Mailing Address - Phone:769-300-0084
Mailing Address - Fax:601-707-5486
Practice Address - Street 1:855 S PEAR ORCHARD RD STE 305
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5114
Practice Address - Country:US
Practice Address - Phone:769-300-0084
Practice Address - Fax:601-707-5486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty