Provider Demographics
NPI:1730916743
Name:GRACEFUL CARE CASE MANAGEMENT
Entity type:Organization
Organization Name:GRACEFUL CARE CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:229-202-7234
Mailing Address - Street 1:716 FOXBOROUGH LN
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3665
Mailing Address - Country:US
Mailing Address - Phone:229-202-7234
Mailing Address - Fax:888-765-7033
Practice Address - Street 1:716 FOXBOROUGH LN
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3665
Practice Address - Country:US
Practice Address - Phone:229-202-7234
Practice Address - Fax:888-765-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty