Provider Demographics
NPI:1255762878
Name:MERCY MINE HOMECARE AGENCY
Entity type:Organization
Organization Name:MERCY MINE HOMECARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-686-2932
Mailing Address - Street 1:2 BALIOL CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-6601
Mailing Address - Country:US
Mailing Address - Phone:336-686-2932
Mailing Address - Fax:
Practice Address - Street 1:2 BALIOL CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-6601
Practice Address - Country:US
Practice Address - Phone:336-686-2932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-08
Last Update Date:2013-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4639251J00000X, 253Z00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care