Provider Demographics
NPI:1548359441
Name:MERCY SERVICES FOR AGING NONPROFIT HOUSING CORPORATION
Entity type:Organization
Organization Name:MERCY SERVICES FOR AGING NONPROFIT HOUSING CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-305-7688
Mailing Address - Street 1:PO BOX 9184
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-9184
Mailing Address - Country:US
Mailing Address - Phone:248-305-7919
Mailing Address - Fax:348-305-7677
Practice Address - Street 1:873 W AVON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2705
Practice Address - Country:US
Practice Address - Phone:248-656-3239
Practice Address - Fax:248-656-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X
MI634018332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI87-3174550Medicaid
MI2672200001Medicare NSC
MI0467860009Medicare NSC