Provider Demographics
NPI:1356123913
Name:FRIENDS OF MERCY HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:FRIENDS OF MERCY HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUFAFA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:240-780-1516
Mailing Address - Street 1:23811 BRANCHBRIER WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4366
Mailing Address - Country:US
Mailing Address - Phone:240-780-1516
Mailing Address - Fax:240-331-0069
Practice Address - Street 1:23811 BRANCHBRIER WAY
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-4366
Practice Address - Country:US
Practice Address - Phone:240-780-1516
Practice Address - Fax:240-331-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care