Provider Demographics
NPI:1548703317
Name:MERCY HOME CARE SERVICES, INC
Entity type:Organization
Organization Name:MERCY HOME CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:UCHEHARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-563-6683
Mailing Address - Street 1:3247 DIAMOND BLF
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-6050
Mailing Address - Country:US
Mailing Address - Phone:404-563-6683
Mailing Address - Fax:
Practice Address - Street 1:3247 DIAMOND BLF
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-6050
Practice Address - Country:US
Practice Address - Phone:404-563-6683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003149067B251J00000X
GA038-R-1093251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003149069AMedicaid
GAHDCHCUK9Medicaid