Provider Demographics
NPI:1700171048
Name:MERCY HOME HEALTH AGENCY
Entity type:Organization
Organization Name:MERCY HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REYNA
Authorized Official - Middle Name:MARLENE
Authorized Official - Last Name:MATEO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:201-658-3944
Mailing Address - Street 1:43 LEXINGTON AVE BSMT
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1601
Mailing Address - Country:US
Mailing Address - Phone:201-435-2020
Mailing Address - Fax:201-495-2055
Practice Address - Street 1:43 LEXINGTON AVE BSMT
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1601
Practice Address - Country:US
Practice Address - Phone:201-435-2020
Practice Address - Fax:201-435-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0154600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health