Provider Demographics
NPI:1417235375
Name:HOUSE OF MERCY
Entity Type:Organization
Organization Name:HOUSE OF MERCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUPATIENT COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ROSSOW
Authorized Official - Suffix:
Authorized Official - Credentials:AA, CADC
Authorized Official - Phone:641-792-0717
Mailing Address - Street 1:200 N 8TH AVE E
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-2108
Mailing Address - Country:US
Mailing Address - Phone:641-792-0717
Mailing Address - Fax:641-792-0730
Practice Address - Street 1:200 N 8TH AVE E
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-2108
Practice Address - Country:US
Practice Address - Phone:641-792-0717
Practice Address - Fax:641-792-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency