Provider Demographics
NPI:1417982497
Name:MERCY HEALTH SERVICES-IOWA, CORP
Entity Type:Organization
Organization Name:MERCY HEALTH SERVICES-IOWA, CORP
Other - Org Name:MERCY HOME HEALTHCARE DUBUQUE
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 1:250 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7320
Mailing Address - Country:US
Mailing Address - Phone:563-589-8899
Mailing Address - Fax:563-589-9122
Practice Address - Street 1:250 MERCY DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7320
Practice Address - Country:US
Practice Address - Phone:563-589-8899
Practice Address - Fax:563-589-9122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH SERVICES- IOWA, CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010100251E00000X
WI197251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0671537Medicaid
IA0671537Medicaid