Provider Demographics
NPI:1558501874
Name:ST. MERCY HOME HEALTH AGENCY, LLC.
Entity Type:Organization
Organization Name:ST. MERCY HOME HEALTH AGENCY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-871-2002
Mailing Address - Street 1:6595 NW 36TH ST
Mailing Address - Street 2:SUITE 101-D
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6979
Mailing Address - Country:US
Mailing Address - Phone:305-871-2002
Mailing Address - Fax:305-871-0004
Practice Address - Street 1:6595 NW 36TH ST
Practice Address - Street 2:SUITE 101-D
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6979
Practice Address - Country:US
Practice Address - Phone:305-871-2002
Practice Address - Fax:305-871-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion