Provider Demographics
| NPI: | 1235934076 |
|---|---|
| Name: | GRACE AND MERCY ESTABLISHMENT |
| Entity type: | Organization |
| Organization Name: | GRACE AND MERCY ESTABLISHMENT |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | TUNEKO |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | PURNELL |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 704-891-8565 |
| Mailing Address - Street 1: | 4106 ANGUS DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | GASTONIA |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 28056-1332 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 704-891-8565 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 223 W MAIN AVE STE E |
| Practice Address - Street 2: | |
| Practice Address - City: | GASTONIA |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 28052-4104 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 704-891-8565 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2025-02-17 |
| Last Update Date: | 2025-04-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 171400000X | Other Service Providers | Health & Wellness Coach | Group - Multi-Specialty | |
| No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
| No | 251B00000X | Agencies | Case Management | ||
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM1000X | Ambulatory Health Care Facilities | Clinic/Center | Migrant Health | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | ||
| No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
