Provider Demographics
NPI:1871288696
Name:GRACE & MERCY COMMUNITY SERVICES INC.
Entity type:Organization
Organization Name:GRACE & MERCY COMMUNITY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-853-8109
Mailing Address - Street 1:4601 PRESIDENTS DRIVE
Mailing Address - Street 2:SUITE 232
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4601 PRESIDENTS DR STE 232
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4870
Practice Address - Country:US
Practice Address - Phone:202-359-9725
Practice Address - Fax:301-441-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD425094000Medicaid