Provider Demographics
NPI:1336506443
Name:MERCY MEDICAL CENTER HOME HEALTH & HOSPICE LLC
Entity Type:Organization
Organization Name:MERCY MEDICAL CENTER HOME HEALTH & HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VP FINANCE / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-489-1131
Mailing Address - Street 1:1050 FORRER BLVD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1472
Mailing Address - Country:US
Mailing Address - Phone:937-299-1111
Mailing Address - Fax:
Practice Address - Street 1:4369 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2643
Practice Address - Country:US
Practice Address - Phone:234-203-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0045HSP251G00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0298771Medicaid
OH0298771Medicaid
OH0298771Medicaid