Provider Demographics
NPI:1326193400
Name:MERCY HOME CARE LLC
Entity Type:Organization
Organization Name:MERCY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDSCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:316-733-9400
Mailing Address - Street 1:822 N ANDOVER RD
Mailing Address - Street 2:PO BOX 580
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-9527
Mailing Address - Country:US
Mailing Address - Phone:316-733-9400
Mailing Address - Fax:316-733-9478
Practice Address - Street 1:822 N ANDOVER RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-9527
Practice Address - Country:US
Practice Address - Phone:316-733-9400
Practice Address - Fax:316-733-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA008011251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200308550AMedicaid