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General NPI Number Information
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NPI Number | 1932195591
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Entity Type | Organization
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Legal Business Name | MERCYGRACE HEALTHCARE, INC.
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 12959 JUPITER ROAD SUITE 140
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City | DALLAS
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State | TX
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Zip | 75238-3200
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Country | US
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Telephone | 214-221-8585
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Fax | 214-221-8586
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Provider Business Mailing Address
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Address Line | 12959 JUPITER RD SUITE 140
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City | DALLAS
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State | TX
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Zip | 75238-3200
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Country | US
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Telephone | 214-221-8585
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Fax | 214-221-8586
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | MS. MERCY C QUACHIE
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Credential | BSC, LNFA
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Telephone | 214-221-8585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 008547
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License Number State | TX
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