Provider Demographics
NPI:1518088632
Name:EL MERCY FLORIDA LLC
Entity Type:Organization
Organization Name:EL MERCY FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-342-6962
Mailing Address - Street 1:5951 NW 151TH STREET
Mailing Address - Street 2:SUITE #108
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014
Mailing Address - Country:US
Mailing Address - Phone:305-364-1251
Mailing Address - Fax:305-364-1956
Practice Address - Street 1:5951 NW 151TH STREET
Practice Address - Street 2:SUITE #108
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-364-1251
Practice Address - Fax:305-364-1956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992713251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299992713OtherAHCA LICENSE
FL651580100Medicaid
FL651580100Medicaid