Healthcare Provider Details

I. General information

NPI: 1649817677
Provider Name (Legal Business Name): GRACE AND MERCY HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E WT HARRIS BLVD STE 118
CHARLOTTE NC
28213-4286
US

IV. Provider business mailing address

2750 E WT HARRIS BLVD STE 118
CHARLOTTE NC
28213-4286
US

V. Phone/Fax

Practice location:
  • Phone: 704-858-1853
  • Fax:
Mailing address:
  • Phone: 704-858-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. NAKITA SHERISE MUMPHERY
Title or Position: DIRECTOR
Credential:
Phone: 704-999-9805