Provider Demographics
NPI:1649817677
Name:GRACE AND MERCY HOME HEALTHCARE, LLC
Entity type:Organization
Organization Name:GRACE AND MERCY HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAKITA
Authorized Official - Middle Name:SHERISE
Authorized Official - Last Name:MUMPHERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-999-9805
Mailing Address - Street 1:2750 E WT HARRIS BLVD STE 118
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4286
Mailing Address - Country:US
Mailing Address - Phone:704-858-1853
Mailing Address - Fax:
Practice Address - Street 1:2750 E WT HARRIS BLVD STE 118
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4286
Practice Address - Country:US
Practice Address - Phone:704-858-1853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No251E00000XAgenciesHome Health
No174200000XOther Service ProvidersMeals
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty