Provider Demographics
NPI:1932195591
Name:MERCYGRACE HEALTHCARE, INC.
Entity Type:Organization
Organization Name:MERCYGRACE HEALTHCARE, INC.
Other - Org Name:GRACE HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:QUACHIE
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, LNFA
Authorized Official - Phone:214-221-8585
Mailing Address - Street 1:12959 JUPITER RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-3200
Mailing Address - Country:US
Mailing Address - Phone:214-221-8585
Mailing Address - Fax:214-221-8586
Practice Address - Street 1:12959 JUPITER ROAD
Practice Address - Street 2:SUITE 140
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-3200
Practice Address - Country:US
Practice Address - Phone:214-221-8585
Practice Address - Fax:214-221-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008547251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001013487Medicaid
TX001013487Medicaid