Provider Demographics
NPI:1578638524
Name:MERCYFULL HOME HEALTH INC
Entity Type:Organization
Organization Name:MERCYFULL HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-320-7658
Mailing Address - Street 1:17111 SIMON CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2600
Mailing Address - Country:US
Mailing Address - Phone:713-320-7658
Mailing Address - Fax:281-232-5500
Practice Address - Street 1:17111 SIMON CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3448
Practice Address - Country:US
Practice Address - Phone:282-232-7500
Practice Address - Fax:281-232-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011131251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHHO78MOtherBLUE CROSS BLUE SHEILD
TX743190Medicare Oscar/Certification