Provider Demographics
NPI:1760199806
Name:GRACE & MERCY PERSONAL CARE PROVIDER LLC
Entity Type:Organization
Organization Name:GRACE & MERCY PERSONAL CARE PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLEAN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-262-3194
Mailing Address - Street 1:24224 MS HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:MATHISTON
Mailing Address - State:MS
Mailing Address - Zip Code:39752-6876
Mailing Address - Country:US
Mailing Address - Phone:662-263-3194
Mailing Address - Fax:
Practice Address - Street 1:63 GWENN RAY DR
Practice Address - Street 2:
Practice Address - City:EUPORA
Practice Address - State:MS
Practice Address - Zip Code:39744-3403
Practice Address - Country:US
Practice Address - Phone:662-258-1018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-28
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care