Healthcare Provider Details

I. General information

NPI: 1497660070
Provider Name (Legal Business Name): GRACE & MERCY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6916 MONTGOMERY BLVD NE STE B-9
ALBUQUERQUE NM
87109-1489
US

IV. Provider business mailing address

8206 LOUISIANA BLVD NE STE A
ALBUQUERQUE NM
87113-1738
US

V. Phone/Fax

Practice location:
  • Phone: 505-487-2802
  • Fax:
Mailing address:
  • Phone: 505-487-2802
  • Fax: 770-502-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLA RICKETTS
Title or Position: OWNER
Credential: APRN
Phone: 516-738-1997