Healthcare Provider Details

I. General information

NPI: 1356650303
Provider Name (Legal Business Name): GRACE & MERCY HUMAN SERVICES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 BLANKENSHIP AVE
LAS VEGAS NV
89106-2230
US

IV. Provider business mailing address

880 BLANKENSHIP AVE
LAS VEGAS NV
89106-2230
US

V. Phone/Fax

Practice location:
  • Phone: 702-489-4226
  • Fax: 702-489-4226
Mailing address:
  • Phone: 702-489-4226
  • Fax: 702-489-4226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number000000000
License Number StateNV

VIII. Authorized Official

Name: BARBARA DEDEAUX
Title or Position: CEO
Credential:
Phone: 702-489-4226