Provider Demographics
NPI:1619973435
Name:ANGELS OF MERCY HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:ANGELS OF MERCY HOME HEALTH CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MERIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-772-1003
Mailing Address - Street 1:PO BOX 461
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-0461
Mailing Address - Country:US
Mailing Address - Phone:580-772-1003
Mailing Address - Fax:580-772-0298
Practice Address - Street 1:914 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-4617
Practice Address - Country:US
Practice Address - Phone:580-765-9241
Practice Address - Fax:580-765-5871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC7359251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKHC7359OtherSTATE LICENSE NUMBER
OK100261920BMedicaid
OKHC7359OtherSTATE LICENSE NUMBER