| Grace N Mercy Support Services Llc | |
|
2420 W Muhammad Ali Blvd Louisville KY 40212-1758 | |
| (270) 300-6819 | |
| (502) 749-0055 |
| Full Name | Grace N Mercy Support Services Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2420 W Muhammad Ali Blvd, Louisville, Kentucky |
| Authorized Official Name and Position | April Roann Robertson (OWNER) |
| Authorized Official Contact | 2703006819 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace N Mercy Support Services Llc 4602 Southern Pkwy Ste 1a Louisville KY 40214-1442 Ph: (270) 300-6819 | Grace N Mercy Support Services Llc 2420 W Muhammad Ali Blvd Louisville KY 40212-1758 Ph: (270) 300-6819 |
| NPI Number | 1548859382 |
|---|---|
| Provider Enumeration Date | 01/15/2021 |
| Last Update Date | 08/12/2021 |
| Certification Date | 08/12/2021 |
| Medicare PECOS PAC ID | 5092120428 |
|---|---|
| Medicare Enrollment ID | O20210217002811 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548859382 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Jason C Ocean |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992108658 PECOS PAC ID: 4587094412 Enrollment ID: I20200416003586 |
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