Provider Demographics
NPI:1699382549
Name:GRACE AND MERCY HOME HEALTH LC
Entity Type:Organization
Organization Name:GRACE AND MERCY HOME HEALTH LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:BSFM
Authorized Official - Phone:843-758-4860
Mailing Address - Street 1:2370 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-5483
Mailing Address - Country:US
Mailing Address - Phone:843-758-4860
Mailing Address - Fax:
Practice Address - Street 1:2370 GREEN RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-5483
Practice Address - Country:US
Practice Address - Phone:843-394-0058
Practice Address - Fax:888-910-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health