Provider Demographics
NPI:1548859382
Name:GRACE N MERCY RESIDENT INCORPORATED
Entity type:Organization
Organization Name:GRACE N MERCY RESIDENT INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:ROANN
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:APSS
Authorized Official - Phone:270-300-6819
Mailing Address - Street 1:4602 SOUTHERN PKWY STE 1A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1442
Mailing Address - Country:US
Mailing Address - Phone:270-300-6819
Mailing Address - Fax:502-749-0055
Practice Address - Street 1:2420 W MUHAMMAD ALI BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212-1758
Practice Address - Country:US
Practice Address - Phone:270-300-6819
Practice Address - Fax:502-749-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty