Healthcare Provider Details

I. General information

NPI: 1962229922
Provider Name (Legal Business Name): GRACE AND MERCY COMMUNITY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 PRESIDENTS DR STE 232
LANHAM MD
20706-4870
US

IV. Provider business mailing address

4601 PRESIDENTS DR STE 232
LANHAM MD
20706-4870
US

V. Phone/Fax

Practice location:
  • Phone: 202-359-9725
  • Fax: 301-441-2360
Mailing address:
  • Phone: 202-359-9725
  • Fax: 301-441-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. MERCY NJWENG FORLU
Title or Position: OWNER/CEO
Credential:
Phone: 301-441-2368