Provider Demographics
NPI:1215398904
Name:MERCY HOME HEALTH
Entity Type:Organization
Organization Name:MERCY HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:
Authorized Official - First Name:ABDIRAHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-703-6932
Mailing Address - Street 1:3055 OLD HIGHWAY 8 STE 101H
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2500
Mailing Address - Country:US
Mailing Address - Phone:612-703-6932
Mailing Address - Fax:
Practice Address - Street 1:3055 OLD HIGHWAY 8 STE 101H
Practice Address - Street 2:
Practice Address - City:SAINT ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-2500
Practice Address - Country:US
Practice Address - Phone:612-703-6932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNHFID32193251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHFID32193OtherSTATE