Healthcare Provider Details

I. General information

NPI: 1922799113
Provider Name (Legal Business Name): MERCY THEN GRACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 N 26TH LN
PHOENIX AZ
85017-3609
US

IV. Provider business mailing address

4600 E WASHINGTON ST STE 300
PHOENIX AZ
85034-1908
US

V. Phone/Fax

Practice location:
  • Phone: 602-826-5636
  • Fax:
Mailing address:
  • Phone: 602-826-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. LATOYA R SIBLEY
Title or Position: CLINICAL OPERATIONS DIRECTOR
Credential: MS, BHT
Phone: 602-826-5636