Healthcare Provider Details

I. General information

NPI: 1124387766
Provider Name (Legal Business Name): THE HANDS OF GRACE AND MERCY ALF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 AVENUE L
FORT PIERCE FL
34947-2362
US

IV. Provider business mailing address

3808 AVENUE L
FORT PIERCE FL
34947-2362
US

V. Phone/Fax

Practice location:
  • Phone: 772-766-5078
  • Fax: 772-409-4408
Mailing address:
  • Phone: 772-766-5078
  • Fax: 772-672-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MS. RUTH H. FREEMAN-WHEELER
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 772-766-5078