Provider Demographics
NPI:1689759425
Name:MERCY HOSPITAL GRAYLING
Entity Type:Organization
Organization Name:MERCY HOSPITAL GRAYLING
Other - Org Name:MERCY MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, MERCY MANOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-348-0337
Mailing Address - Street 1:1100 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-1312
Mailing Address - Country:US
Mailing Address - Phone:989-348-0337
Mailing Address - Fax:989-348-0529
Practice Address - Street 1:1100 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-1312
Practice Address - Country:US
Practice Address - Phone:989-348-0337
Practice Address - Fax:989-348-0529
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH-MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-5201Medicare Oscar/Certification