Provider Demographics
NPI:1861642761
Name:GRACE AND MERCY HEALTH SERVICES.
Entity Type:Organization
Organization Name:GRACE AND MERCY HEALTH SERVICES.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:MBANDI
Authorized Official - Last Name:FORLU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:202-359-9725
Mailing Address - Street 1:4601 PRESIDENTS DR STE 232
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4870
Mailing Address - Country:US
Mailing Address - Phone:202-359-9725
Mailing Address - Fax:301-441-2360
Practice Address - Street 1:4601 PRESIDENTS DR STE 232
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4870
Practice Address - Country:US
Practice Address - Phone:202-359-9725
Practice Address - Fax:301-441-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNSA-0208251C00000X
MDR2494251J00000X
MD0705009251J00000X
DC400315904666253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC039843400Medicaid
MD966201400Medicaid
MD966202200Medicaid
MD416061400Medicaid
MD5966201400Medicaid