Provider Demographics
NPI:1669600540
Name:GRACE & MERCY HOUSE INC.
Entity type:Organization
Organization Name:GRACE & MERCY HOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-636-3144
Mailing Address - Street 1:PO BOX 694
Mailing Address - Street 2:
Mailing Address - City:LANDIS
Mailing Address - State:NC
Mailing Address - Zip Code:28088-0694
Mailing Address - Country:US
Mailing Address - Phone:704-636-3144
Mailing Address - Fax:704-636-1311
Practice Address - Street 1:104 S. LONG STREET
Practice Address - Street 2:
Practice Address - City:EAST SPENCER
Practice Address - State:NC
Practice Address - Zip Code:28039
Practice Address - Country:US
Practice Address - Phone:704-636-3144
Practice Address - Fax:704-636-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health