Provider Demographics
NPI:1205821816
Name:MERCY AMICARE HOME HEALTHCARE, PORT HURON
Entity Type:Organization
Organization Name:MERCY AMICARE HOME HEALTHCARE, PORT HURON
Other - Org Name:ST. JOSEPH MERCY HOME CARE, PORT HURON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-542-8279
Mailing Address - Street 1:P.O. BOX 9185
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-9185
Mailing Address - Country:US
Mailing Address - Phone:734-542-8220
Mailing Address - Fax:734-542-8286
Practice Address - Street 1:505 HURON AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3805
Practice Address - Country:US
Practice Address - Phone:810-966-3040
Practice Address - Fax:810-966-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3376644Medicaid
MIOE134OtherBLUE CROSS
MIOE134OtherBLUE CROSS