Healthcare Provider Details

I. General information

NPI: 1598785917
Provider Name (Legal Business Name): MERCY N GRACE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6618 IRONGATE DR
RICHMOND VA
23234
US

IV. Provider business mailing address

PO BOX 34653
RICHMOND VA
23234-0653
US

V. Phone/Fax

Practice location:
  • Phone: 804-279-0736
  • Fax: 804-562-5810
Mailing address:
  • Phone: 804-536-5770
  • Fax: 804-861-0172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KEHINDE DUPE OGUNBUNMI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 804-536-5770