Provider Demographics
NPI:1891898375
Name:ANGELS OF MERCY HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:ANGELS OF MERCY HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DESSELLES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-442-6435
Mailing Address - Street 1:2217 SHREVEPORT HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360
Mailing Address - Country:US
Mailing Address - Phone:318-442-6435
Mailing Address - Fax:318-442-7839
Practice Address - Street 1:2217 SHREVEPORT HWY
Practice Address - Street 2:SUITE B
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-442-6435
Practice Address - Fax:318-442-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1403369Medicaid
LA197458Medicare ID - Type Unspecified