Provider Demographics
NPI:1649539644
Name:DAUGHTERS OF MARY MOTHER OF MERCY
Entity type:Organization
Organization Name:DAUGHTERS OF MARY MOTHER OF MERCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MASTERS DEGREE
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:OBIAGELI
Authorized Official - Last Name:EMEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:347-278-5287
Mailing Address - Street 1:2021 S BRADDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:SWISSVALE
Mailing Address - State:PA
Mailing Address - Zip Code:15218-2124
Mailing Address - Country:US
Mailing Address - Phone:347-278-5287
Mailing Address - Fax:
Practice Address - Street 1:2021 S BRADDOCK AVE
Practice Address - Street 2:
Practice Address - City:SWISSVALE
Practice Address - State:PA
Practice Address - Zip Code:15218-2124
Practice Address - Country:US
Practice Address - Phone:347-278-5287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAUGHTERS OF MARY MOTHER OF MERCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANONE251E00000X
PA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health