Provider Demographics
NPI:1518133719
Name:MERCY HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:MERCY HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TESSIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HATLEVIG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:219-714-1317
Mailing Address - Street 1:3235 45TH ST
Mailing Address - Street 2:#107
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3284
Mailing Address - Country:US
Mailing Address - Phone:219-714-1317
Mailing Address - Fax:219-923-4385
Practice Address - Street 1:3235 45TH ST
Practice Address - Street 2:#107
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3284
Practice Address - Country:US
Practice Address - Phone:219-714-1317
Practice Address - Fax:219-923-4385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15-7622Medicare PIN