Provider Demographics
NPI:1043962202
Name:MERCY HEALTH CARE LLC
Entity Type:Organization
Organization Name:MERCY HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:IBRAHIM
Authorized Official - Last Name:ZAHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:651-353-7952
Mailing Address - Street 1:8931 FARNSWORTH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1752
Mailing Address - Country:US
Mailing Address - Phone:651-353-2795
Mailing Address - Fax:
Practice Address - Street 1:8931 FARNSWORTH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1752
Practice Address - Country:US
Practice Address - Phone:651-353-2795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1969Medicaid