Provider Demographics
NPI:1407842552
Name:MERCY HOME CARE & HOSPICE-CLINTON
Entity Type:Organization
Organization Name:MERCY HOME CARE & HOSPICE-CLINTON
Other - Org Name:MERCY HOME CARE & HOSPICE-CLINTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHINBORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-244-3766
Mailing Address - Street 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5067
Mailing Address - Country:US
Mailing Address - Phone:563-244-3766
Mailing Address - Fax:563-244-3719
Practice Address - Street 1:915 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5067
Practice Address - Country:US
Practice Address - Phone:563-244-3766
Practice Address - Fax:563-244-3719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY MEDICAL CENTER-CLINTON, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-23
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL001008127251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0671552Medicaid
IL=========004Medicaid
IA167154Medicare Oscar/Certification