Grace and Mercy Personal Care and Respite Service, LLC

Primary specialty

HomemakerTaxonomy code 376J00000X

Legal business name

GRACE AND MERCY PERSONAL CARE AND RESPITE SERVICE, LLC

Practice address

410 Masonic Drive
Clinton, MS 39056

Phone

(601) 488-4027

Fax

(601) 488-4128

NPI assigned

Jan 11, 2007

Last updated

Dec 18, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sylviaette Harris

Title

Administrator

Phone

(601) 488-4027

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• GENA'S FOUR SEASONS Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545091200000",
    "number": "1790835635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 374",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "39060",
            "telephone_number": "601-488-4027",
            "fax_number": "601-488-4128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 MASONIC DRIVE",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "39056",
            "telephone_number": "601-488-4027",
            "fax_number": "601-488-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE AND MERCY PERSONAL CARE AND RESPITE SERVICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2018-12-18",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "SYLVIAETTE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-488-4027"
    },
    "taxonomies": [
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08778761",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07680072",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GENA'S FOUR SEASONS",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "GENA'S FOUR SEASONS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• John Melvin Goolsby Jr., DMD
• Ariel Gordon
• Maxie Lerone Gordon, MD
• Michael Deshuan Gordon, LPC
• Gptrs II (Genesis Physical Therapy and Rehabilitation Services)
• William M Grantham, MD
• Ashton Wilson Graves
• Zina Bonita Gray
• Becquelyn Green
• Lakeisha Crye Green, PMHNP-BC

• Homemaker in Clinton, MS
• Providers in Clinton, MS by specialty
• Homemaker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.