Provider Demographics
NPI:1619029139
Name:MERCY ASSISTED CARE, INC
Entity Type:Organization
Organization Name:MERCY ASSISTED CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-971-6738
Mailing Address - Street 1:1010 N. WASHINGTON ST,
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548
Mailing Address - Country:US
Mailing Address - Phone:608-755-7989
Mailing Address - Fax:608-741-6798
Practice Address - Street 1:1236 BARBERRY DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0457
Practice Address - Country:US
Practice Address - Phone:815-943-2071
Practice Address - Fax:815-943-8157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
WI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41691700Medicaid
WI41691700Medicaid
1067690002Medicare NSC