Provider Demographics
NPI:1396022216
Name:GRACE AND MERCY HUMAN SERVICES INC
Entity Type:Organization
Organization Name:GRACE AND MERCY HUMAN SERVICES INC
Other - Org Name:GRACE AND MERCY MENTAL HEALTH AND WELLNESS AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEDEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-272-4393
Mailing Address - Street 1:880 BLANKENSHIP AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2230
Mailing Address - Country:US
Mailing Address - Phone:702-272-4393
Mailing Address - Fax:702-489-4226
Practice Address - Street 1:880 BLANKENSHIP AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2230
Practice Address - Country:US
Practice Address - Phone:702-272-4393
Practice Address - Fax:702-489-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-06
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20081080217251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health