| Southern Grace Healthcare Inc. | |
|
820 S Locust St Ashdown AR 71822-4347 | |
| (870) 898-4576 | |
| (870) 455-4484 |
| Full Name | Southern Grace Healthcare Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 820 S Locust St, Ashdown, Arkansas |
| Authorized Official Name and Position | Alexandria Davis (OWNER) |
| Authorized Official Contact | 8708984576 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Grace Healthcare Inc. 820 S Locust St Ashdown AR 71822-4347 Ph: () - | Southern Grace Healthcare Inc. 820 S Locust St Ashdown AR 71822-4347 Ph: (870) 898-4576 |
| NPI Number | 1679243653 |
|---|---|
| Provider Enumeration Date | 09/20/2021 |
| Last Update Date | 11/18/2024 |
| Medicare PECOS PAC ID | 1951799857 |
|---|---|
| Medicare Enrollment ID | O20211026002508 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679243653 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Alexandria A Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962980797 PECOS PAC ID: 9032460191 Enrollment ID: I20180928001508 |
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