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General NPI Number Information
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NPI Number | 1922799113
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Entity Type | Organization
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Legal Business Name | MERCY THEN GRACE LLC
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 4701 N 26TH LN
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City | PHOENIX
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State | AZ
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Zip | 85017-3609
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Country | US
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Telephone | 602-826-5636
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 E WASHINGTON ST STE 300
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City | PHOENIX
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State | AZ
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Zip | 85034-1908
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Country | US
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Telephone | 602-826-5636
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Fax |
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Authorized Official
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Title or Position | CLINICAL OPERATIONS DIRECTOR
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Name | MRS. LATOYA R SIBLEY
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Credential | MS, BHT
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Telephone | 602-826-5636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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