Provider Demographics
NPI:1730473109
Name:MERCED HOME, INC
Entity Type:Organization
Organization Name:MERCED HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REYNALDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-714-7363
Mailing Address - Street 1:12446 SUMMERWIND ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8328
Mailing Address - Country:US
Mailing Address - Phone:562-716-5958
Mailing Address - Fax:562-402-1411
Practice Address - Street 1:11451 TRUE WAY
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-2330
Practice Address - Country:US
Practice Address - Phone:714-583-8572
Practice Address - Fax:714-761-1747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000434315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities