Provider Demographics
NPI:1720576440
Name:NEW MERCYS CARE LLC
Entity Type:Organization
Organization Name:NEW MERCYS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:850-570-9994
Mailing Address - Street 1:1458 RUSTLING PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32343-2239
Mailing Address - Country:US
Mailing Address - Phone:850-570-9994
Mailing Address - Fax:850-765-5904
Practice Address - Street 1:1458 RUSTLING PINES BLVD
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:FL
Practice Address - Zip Code:32343-2239
Practice Address - Country:US
Practice Address - Phone:850-570-9994
Practice Address - Fax:850-765-5904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL131593104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020311800Medicaid