Provider Demographics
NPI:1306497482
Name:GRACE & MERCY HOME HEALTHCARE, LLC
Entity type:Organization
Organization Name:GRACE & MERCY HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-310-5280
Mailing Address - Street 1:2039 W DEKALB ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-2043
Mailing Address - Country:US
Mailing Address - Phone:803-310-5280
Mailing Address - Fax:803-572-4318
Practice Address - Street 1:2039 W DEKALB ST STE 2
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-2043
Practice Address - Country:US
Practice Address - Phone:803-310-5280
Practice Address - Fax:803-572-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty