Organization
GRACE INDEPENDENT LIVING STORE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JUNE M ALFORD (C.E.O./OWNER)
(601) 260-6674
Entity
Organization
Contact information
Practice address
655 LAKE HARBOUR DR STE 1100, RIDGELAND, MS 39157-4360
(601) 499-5350
Mailing address
PO BOX 1140, RIDGELAND, MS 39158-1140
(601) 499-5350
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
16852.11.1
MS
332B00000X
Durable Medical Equipment & Medical Supplies
—
MS
Other
Enumeration date
03/13/2018
Last updated
03/13/2018
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