Provider Demographics
NPI:1265544746
Name:MERCY HEALTH SERVICES LLC
Entity type:Organization
Organization Name:MERCY HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-674-1699
Mailing Address - Street 1:5150 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2620
Mailing Address - Country:US
Mailing Address - Phone:985-674-1699
Mailing Address - Fax:985-626-7473
Practice Address - Street 1:5150 HIGHWAY 22 STE C9
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-2668
Practice Address - Country:US
Practice Address - Phone:985-674-1699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1406686Medicaid
LA1406686Medicaid