Provider Demographics
NPI:1871852616
Name:HEART OF MERCY HOSPICE
Entity Type:Organization
Organization Name:HEART OF MERCY HOSPICE
Other - Org Name:MERCY HOSPICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:956-562-2985
Mailing Address - Street 1:9595 SIX PINES DR STE 8210
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1642
Mailing Address - Country:US
Mailing Address - Phone:956-562-2985
Mailing Address - Fax:832-200-3005
Practice Address - Street 1:9595 SIX PINES DR STE 8210
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1642
Practice Address - Country:US
Practice Address - Phone:956-562-2985
Practice Address - Fax:832-200-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64155302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2819765-01Medicaid