Provider Demographics
NPI:1326257965
Name:MERCY HOME SERVICES INC.
Entity Type:Organization
Organization Name:MERCY HOME SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEOSPHINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-375-8399
Mailing Address - Street 1:1119 HILLCROFT RD
Mailing Address - Street 2:
Mailing Address - City:BROWNS SUMMIT
Mailing Address - State:NC
Mailing Address - Zip Code:27214-9205
Mailing Address - Country:US
Mailing Address - Phone:336-375-8399
Mailing Address - Fax:336-375-8399
Practice Address - Street 1:1119 HILLCROFT RD
Practice Address - Street 2:
Practice Address - City:BROWNS SUMMIT
Practice Address - State:NC
Practice Address - Zip Code:27214-9205
Practice Address - Country:US
Practice Address - Phone:336-375-8399
Practice Address - Fax:336-375-8399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041736320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00000000000000Medicaid