Provider Demographics
NPI:1396516969
Name:MERCY OF ZION HOME LLC
Entity type:Organization
Organization Name:MERCY OF ZION HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLANREWAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:ONAOLAPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-348-1522
Mailing Address - Street 1:5331 N MACARTHUR BLVD APT 2096
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-8756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5331 N MACARTHUR BLVD APT 2096
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-8756
Practice Address - Country:US
Practice Address - Phone:214-288-8070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility