MEDICARE: MERCY AND GRACE HOME HEALTH CARE AND HOSPICE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		CA

General Provider Information

NPI Number	:	1235523960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY AND GRACE HOME HEALTH CARE AND HOSPICE SERVICES LLC

Provider Business Mailing Address
First Line	:	1516 OAK ST
Second Line	:	SUITE 104
City	:	ALAMEDA
State	:	CA
Zip	:	94501-2947
Country	:	US
Telephone Number	:	510-697-8824
Fax Number	:	510-356-2515

Provider Business Practice Location Address
First Line	:	1516 OAK ST
Second Line	:	SUITE 104
City	:	ALAMEDA
State	:	CA
Zip	:	94501-2947
Country	:	US
Telephone Number	:	510-697-8824
Fax Number	:	510-356-2515

Authorized Official
Title or Position	:	CEO
Name	:	MS. JOEMERCY LINGAN
Credential	:	RN
Telephone Number	:	510-388-4831

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	03/19/2015

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