1366137168 NPI number — GRACE AND MERCY COMMUNITY SERVICES INCORPORATED

Table of content: (NPI 1366137168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366137168 NPI number — GRACE AND MERCY COMMUNITY SERVICES INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACE AND MERCY COMMUNITY SERVICES INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366137168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 PRESIDENTS DRIVE
Provider Second Line Business Mailing Address:
SUITE 232
Provider Business Mailing Address City Name:
LANHAM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4601 PRESIDENTS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 232
Provider Business Practice Location Address City Name:
LANHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-853-8109
Provider Business Practice Location Address Fax Number:
301-441-2360
Provider Enumeration Date:
04/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
FORLU
Authorized Official First Name:
MERCY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
202-359-9725

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0807X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 425096600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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