| Organization Name: | SOUTHERN GRACE SERVICES |
| NPI Number: | 1295193589 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALISA BERTEAU (OWNER) |
| Mailing Address: | 1208a Carterville Rd Petal |
| State: | MS US |
| Postal Code: | 394653115 |
| Phone Number: | 6016025411 |
| Fax Number: | 6016025410 |
| NPI Enumeration Date: | 02/02/2016 |
| NPI Last Update Date: | 02/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |