Provider Demographics
NPI:1942835806
Name:MERCY FAVOR AND GRACE SOCIAL SERVICES
Entity Type:Organization
Organization Name:MERCY FAVOR AND GRACE SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ATINUKE
Authorized Official - Middle Name:COMFORT
Authorized Official - Last Name:OKUNADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-918-5492
Mailing Address - Street 1:9431 W SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4435
Mailing Address - Country:US
Mailing Address - Phone:602-918-5492
Mailing Address - Fax:623-223-9225
Practice Address - Street 1:9431 W SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4435
Practice Address - Country:US
Practice Address - Phone:602-918-5492
Practice Address - Fax:623-223-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness