Provider Demographics
NPI:1639348022
Name:MERCY HOME FOR CHILDEN, INC.,
Entity Type:Organization
Organization Name:MERCY HOME FOR CHILDEN, INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SR. CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMLISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-832-1075
Mailing Address - Street 1:243 PROSPECT PARK WEST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5807
Mailing Address - Country:US
Mailing Address - Phone:718-832-1075
Mailing Address - Fax:718-499-9189
Practice Address - Street 1:345 WARREN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6412
Practice Address - Country:US
Practice Address - Phone:718-852-8613
Practice Address - Fax:718-852-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00357011OtherMEDICAID PROVIDER ID #