Provider Demographics
NPI:1730300294
Name:OUR LADY OF MERCY HEALTH CARE CENTER, INC
Entity Type:Organization
Organization Name:OUR LADY OF MERCY HEALTH CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-798-3727
Mailing Address - Street 1:101 BARRY RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1154
Mailing Address - Country:US
Mailing Address - Phone:508-798-3727
Mailing Address - Fax:508-757-9415
Practice Address - Street 1:101 BARRY RD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1154
Practice Address - Country:US
Practice Address - Phone:508-798-3727
Practice Address - Fax:508-757-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1T61311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5508746Medicaid