Provider Demographics
NPI:1083215305
Name:MERCY SERVICES, LLC
Entity Type:Organization
Organization Name:MERCY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-374-2593
Mailing Address - Street 1:4302 BLUE RIBBON RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-5988
Mailing Address - Country:US
Mailing Address - Phone:317-374-2593
Mailing Address - Fax:317-981-1985
Practice Address - Street 1:3960 SOUTHEASTERN AVE STE 113
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-1571
Practice Address - Country:US
Practice Address - Phone:317-374-2593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300027988Medicaid