Provider Demographics
NPI:1609163351
Name:SISTERS OF MERCY MINISTRIES D/B/A MERCY FAMILY CENTER
Entity Type:Organization
Organization Name:SISTERS OF MERCY MINISTRIES D/B/A MERCY FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
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 STE 425
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 VETERANS MEMORIAL BLVD STE 425
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4959
Practice Address - Country:US
Practice Address - Phone:504-838-8283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SISTERS OF MERCY HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2127349Medicaid