Healthcare Provider Details

I. General information

NPI: 1871288696
Provider Name (Legal Business Name): GRACE & MERCY COMMUNITY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
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 DRIVE SUITE 232
LANHAM MD
20706
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MERCY FORLU
Title or Position: DIRECTOR
Credential:
Phone: 202-853-8109