Provider Demographics
NPI:1558768101
Name:GRACE AND MERCY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:GRACE AND MERCY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:OGEH
Authorized Official - Last Name:CATERNOR
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-670-8045
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-0004
Mailing Address - Country:US
Mailing Address - Phone:410-670-8045
Mailing Address - Fax:
Practice Address - Street 1:2108 EMMORTON PARK RD
Practice Address - Street 2:101-103
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-1050
Practice Address - Country:US
Practice Address - Phone:410-670-8045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR159033261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service