Provider Demographics
NPI:1255107074
Name:GOD'S MERCY AND GRACE GROUP HOME INC
Entity type:Organization
Organization Name:GOD'S MERCY AND GRACE GROUP HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TUNDE
Authorized Official - Middle Name:SEGUN
Authorized Official - Last Name:AKINSAWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-657-0024
Mailing Address - Street 1:617 W PATRICK ST STE 2
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4027
Mailing Address - Country:US
Mailing Address - Phone:443-657-0024
Mailing Address - Fax:
Practice Address - Street 1:617 W PATRICK ST STE 2
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4027
Practice Address - Country:US
Practice Address - Phone:443-657-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities