Organization
MICK INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL GRACE (MANAGER)
(601) 974-6085
Entity
Organization
Contact information
Practice address
334 JOSANNA STREET, SUITE #209, JACKSON, MS 39202
(601) 974-6085
(601) 974-6099
Mailing address
334 JOSANNA STREET, SUITE #209, JACKSON, MS 39202
(601) 974-6085
(601) 974-6099
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
3747A0650X
Attendant Care Provider
—
—
Other
Enumeration date
03/03/2010
Last updated
06/27/2011
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