Provider Demographics
NPI:1518404276
Name:GRACE AND MERCY HEALTH CARE SERVICES,LLC
Entity Type:Organization
Organization Name:GRACE AND MERCY HEALTH CARE SERVICES,LLC
Other - Org Name:GRACE AND MERCY HEALTH CARE SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSE PRACTICAL NURSE , FOUNDER,
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANERVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-809-9031
Mailing Address - Street 1:875 NORTHPARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5223
Mailing Address - Country:US
Mailing Address - Phone:601-809-9031
Mailing Address - Fax:601-709-3581
Practice Address - Street 1:875 NORTHPARK DR STE 100
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5223
Practice Address - Country:US
Practice Address - Phone:601-809-9031
Practice Address - Fax:601-709-3581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X, 261QH0100X, 343900000X, 385H00000X
MS326285251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251G00000XAgenciesHospice Care, Community Based
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care