Provider Demographics
NPI:1285857862
Name:ACT OF MERCY HOME CARE SERVICE INC
Entity Type:Organization
Organization Name:ACT OF MERCY HOME CARE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORDELIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-365-6920
Mailing Address - Street 1:902 JEFFERSON TERRACE
Mailing Address - Street 2:STE E
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560
Mailing Address - Country:US
Mailing Address - Phone:337-365-6920
Mailing Address - Fax:866-281-1438
Practice Address - Street 1:902 JEFFERSON TERRACE
Practice Address - Street 2:STE E
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560
Practice Address - Country:US
Practice Address - Phone:337-365-6920
Practice Address - Fax:866-281-1438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1736333376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1736333Medicaid