HOME OF GRACE COUNSELING SERVICES, LLC (NPI# 1053935940) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053935940 |
| Entity Type | Organization |
| Organization Name | HOME OF GRACE COUNSELING SERVICES, LLC |
| Practice Address |
14200 Jericho Rd Vancleave MS 39565-9771 |
| Mailing Address |
Po Box 5009 Vancleave MS 39565-5009 |
| Practice Telephone | 2288265283 |
| Practice Fax Number | 2288261663 |
| Mailing Telephone | 2288265283 |
| Mailing Fax Number | 2288261663 |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2020-07-20 |
| Authorized Official Name | MR. JOSHUA BARTON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2288266522 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities | ||
| N | 276400000X | Rehabilitation, Substance Use Disorder Unit | Hospital Units | ||
| N | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities | ||
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 7112 Home of Grace Dr, Gautier, MS 395532728 | 2284971312 | 2288261663 |
| Street Address |
14200 JERICHO RD |
| City | VANCLEAVE |
| State | MS |
| Zip Code | 39565-9771 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548761950 | Jake Wallace Carzoli | Nurse Practitioner | 11700 Ms-57, Vancleave, MS 39565 | 2018-02-22 |
| 1992129316 | Ashlynn Evan Crum | Speech-Language Pathologist | 8728 Doobie Ct., Vancleave, MS 39565 | 2014-02-05 |
| 1851695720 | Coast Nurse Practitioners, Inc. | Nurse Practitioner | 13300 R.s. Kimball Road, Vancleave, MS 39565 | 2011-01-06 |
| 1538484761 | Sarah Burke | Speech-Language Pathologist | 477 Colonel Vickrey Road, Vancleave, MS 39565 | 2010-03-31 |
| 1194058842 | Jackson County School District | Local Education Agency (LEA) | 4700 Colonel Vickrey Road, Vancleave, MS 39565 | 2009-09-14 |
| 1962566224 | John Michael Martin | Nurse Practitioner | 1330 R S Kimball, Vancleave, MS 39565 | 2006-12-21 |
| 1619919156 | Lennon E. Bowen Iv | Psychiatry & Neurology | 6300 E Lake Blvd Ste 201, Vancleave, MS 39565 | 2006-06-11 |
| 1396233490 | Dorian R Blake | Nurse Practitioner | 6300 E Lake Blvd Ste 201, Vancleave, MS 39565 | 2018-04-25 |
| 1164971867 | Clarissa Picard | Occupational Therapist | 6300 East Lake Blvd., Suite 301, Vancleave, MS 39565 | 2016-09-23 |
| 1629427174 | Amanda Rayburn | Registered Nurse | 6300 E Lake Blvd Ste 201, Vancleave, MS 39565 | 2016-06-06 |
| Find all providers in zip 39565 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.