Basic Information
| Provider Information | |||||||||
| NPI: | 1215488606 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GRACE HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 CHERRYWOOD PL | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383051741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316681900 | ||||||||
| FaxNumber: | 7316642175 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 CHERRYWOOD PL | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383051741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316681900 | ||||||||
| FaxNumber: | 7316642175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2016 | ||||||||
| LastUpdateDate: | 10/20/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MESHKANI-MEHDIAN | ||||||||
| AuthorizedOfficialFirstName: | ANAHITA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | FAMILY NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 7316952165 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | MSN , FNP-C | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | APN0000021900 | TN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.