Provider Demographics
NPI:1417193137
Name:ANGELS OF MERCY GROUP HOME, INC.
Entity Type:Organization
Organization Name:ANGELS OF MERCY GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-472-3529
Mailing Address - Street 1:837 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-4701
Mailing Address - Country:US
Mailing Address - Phone:318-354-1888
Mailing Address - Fax:318-354-1889
Practice Address - Street 1:1320 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-4837
Practice Address - Country:US
Practice Address - Phone:318-354-1888
Practice Address - Fax:318-354-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization