Provider Demographics
NPI:1982873402
Name:MERCY HOME FOR CHILDREN, INC.
Entity Type:Organization
Organization Name:MERCY HOME FOR CHILDREN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIEVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SR.CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMLISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-832-1075
Mailing Address - Street 1:243 PROSPECT PARK W
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5807
Mailing Address - Country:US
Mailing Address - Phone:718-832-1075
Mailing Address - Fax:
Practice Address - Street 1:878 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2309
Practice Address - Country:US
Practice Address - Phone:718-349-2377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01114965OtherMEDICAID PROVDIER ID #