Provider Demographics
NPI:1700225786
Name:MERCYFULL HOME HEALTH
Entity Type:Organization
Organization Name:MERCYFULL HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-320-7658
Mailing Address - Street 1:5330 MONTEREY HWY APT J2
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-4214
Mailing Address - Country:US
Mailing Address - Phone:713-320-7658
Mailing Address - Fax:
Practice Address - Street 1:5330 MONTEREY HWY APT J2
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-4214
Practice Address - Country:US
Practice Address - Phone:713-320-7658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-23
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health