Provider Demographics
NPI:1124387766
Name:THE HANDS OF GRACE AND MERCY ALF
Entity Type:Organization
Organization Name:THE HANDS OF GRACE AND MERCY ALF
Other - Org Name:THE HANDS OF GRACE AND MERCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:H
Authorized Official - Last Name:FREEMAN-WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-766-5078
Mailing Address - Street 1:3808 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-2362
Mailing Address - Country:US
Mailing Address - Phone:772-766-5078
Mailing Address - Fax:772-672-4650
Practice Address - Street 1:3808 AVENUE L
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-2362
Practice Address - Country:US
Practice Address - Phone:772-766-5078
Practice Address - Fax:772-409-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002457900OtherASSIST PEOPLE WITH DISIBILITY
FL002457900Medicaid
FL00245790OtherHOME AND COMMUNITY BASE