Organization
GRACERIDGE INC
Active
Organization
GRACERIDGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KELLY GROJEAN (PRESIDENT)
(870) 530-9706
Entity
Organization
Contact information
Practice address
3909 HILL DR, JONESBORO, AR 72401-8850
(870) 935-5961
Mailing address
902 CHESTNUT ST, JONESBORO, AR 72401-3801
(870) 530-9706
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
223545732
—
AR
Enumeration date
04/04/2019
Last updated
06/11/2019
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