Provider Demographics
NPI:1467114066
Name:MERCY HOUSE LIVING CENTERS
Entity Type:Organization
Organization Name:MERCY HOUSE LIVING CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-836-7188
Mailing Address - Street 1:PO BOX 1905
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92702-1905
Mailing Address - Country:US
Mailing Address - Phone:714-836-7188
Mailing Address - Fax:714-836-7901
Practice Address - Street 1:203 N GOLDEN CIRCLE DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4010
Practice Address - Country:US
Practice Address - Phone:714-836-7188
Practice Address - Fax:714-836-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management