Provider Demographics
NPI:1346616968
Name:SAINT JOSEPH'S MERCY CARE SERVICES, INC.
Entity Type:Organization
Organization Name:SAINT JOSEPH'S MERCY CARE SERVICES, INC.
Other - Org Name:SAINT JOSEPH'S MERCY CARE - COR BEHAVIOR HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-843-8502
Mailing Address - Street 1:424 DECATUR ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1848
Mailing Address - Country:US
Mailing Address - Phone:678-843-8600
Mailing Address - Fax:
Practice Address - Street 1:1300 JOSEPH E BOONE BLVD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-2032
Practice Address - Country:US
Practice Address - Phone:678-843-8600
Practice Address - Fax:678-843-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000649844JMedicaid
GA111000Medicare PIN