Provider Demographics
NPI:1497895262
Name:MERCY FAMILY CENTER
Entity Type:Organization
Organization Name:MERCY FAMILY CENTER
Other - Org Name:SISTERS OF MERCY MINISTRIES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:
Authorized Official - Last Name:MENASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-838-3235
Mailing Address - Street 1:110 VETERANS MEMORIAL BLVD.
Mailing Address - Street 2:SUITE 425
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-4959
Mailing Address - Country:US
Mailing Address - Phone:504-838-8283
Mailing Address - Fax:877-472-2158
Practice Address - Street 1:110 VETERANS MEMORIAL BLVD.
Practice Address - Street 2:SUITE 425
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4959
Practice Address - Country:US
Practice Address - Phone:888-950-0003
Practice Address - Fax:877-472-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA103TC0700X, 103TC2200X, 1041C0700X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1455946Medicaid