Provider Demographics
NPI:1710780648
Name:GRACEFUL JOURNEYS LLC
Entity type:Organization
Organization Name:GRACEFUL JOURNEYS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-260-8526
Mailing Address - Street 1:PO BOX 1762
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-1762
Mailing Address - Country:US
Mailing Address - Phone:601-260-8526
Mailing Address - Fax:
Practice Address - Street 1:120 OLD HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-8788
Practice Address - Country:US
Practice Address - Phone:601-260-8526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-27
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle