Provider Demographics
NPI:1083200497
Name:MERCI HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:MERCI HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARENA
Authorized Official - Middle Name:SPELLER
Authorized Official - Last Name:DIYOMBI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:706-332-8175
Mailing Address - Street 1:113 VILLAGE PL
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-5708
Mailing Address - Country:US
Mailing Address - Phone:706-332-8175
Mailing Address - Fax:
Practice Address - Street 1:113 VILLAGE PL
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-5708
Practice Address - Country:US
Practice Address - Phone:706-332-8175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHCP010909OtherPRIVATE HOMECARE PROVIDER PERMIT