Provider Demographics
NPI:1093725418
Name:MERCY HEALTH - WILLARD HOSPITAL LLC
Entity Type:Organization
Organization Name:MERCY HEALTH - WILLARD HOSPITAL LLC
Other - Org Name:MERCY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:DETTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-964-5212
Mailing Address - Street 1:110 E HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-1611
Mailing Address - Country:US
Mailing Address - Phone:419-964-5000
Mailing Address - Fax:
Practice Address - Street 1:2459 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8822
Practice Address - Country:US
Practice Address - Phone:419-443-8030
Practice Address - Fax:419-443-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
375148OtherJCAHO
OH0954490Medicaid
375148OtherJCAHO