Provider Demographics
NPI:1417722836
Name:MERCY HOMES ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:MERCY HOMES ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WYCLIFFE
Authorized Official - Middle Name:O
Authorized Official - Last Name:OPIYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-781-6512
Mailing Address - Street 1:2901 ASBURY AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1335
Mailing Address - Country:US
Mailing Address - Phone:817-781-6512
Mailing Address - Fax:
Practice Address - Street 1:2901 ASBURY AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1335
Practice Address - Country:US
Practice Address - Phone:817-781-6512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services