Provider Demographics
NPI:1356013353
Name:MERCY LAND HOME HEALTH LLC
Entity Type:Organization
Organization Name:MERCY LAND HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADERONKE
Authorized Official - Middle Name:
Authorized Official - Last Name:AJIBULU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-638-5448
Mailing Address - Street 1:203 THORNBURY ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-9328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:203 THORNBURY ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-9328
Practice Address - Country:US
Practice Address - Phone:919-638-5448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care