Provider Demographics
NPI:1891771481
Name:ANGELS OF MERCY HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:ANGELS OF MERCY HOME HEALTH CARE, LLC
Other - Org Name:ANGELS OF MERCY HOMECARE PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-928-2727
Mailing Address - Street 1:1800 N WABASH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-1300
Mailing Address - Country:US
Mailing Address - Phone:765-651-3242
Mailing Address - Fax:765-651-3246
Practice Address - Street 1:1800 N WABASH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1300
Practice Address - Country:US
Practice Address - Phone:765-651-3242
Practice Address - Fax:765-651-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN003890251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN003890OtherISBH LICENSE NUMBER
IN003890OtherISBH LICENSE NUMBER