Provider Demographics
NPI:1366137168
Name:GRACE AND MERCY COMMUNITY SERVICES INCORPORATED
Entity type:Organization
Organization Name:GRACE AND MERCY COMMUNITY SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-359-9725
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 DRIVE
Practice Address - Street 2:SUITE 232
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:202-853-8109
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:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD425096600Medicaid