Basic Information
| Provider Information | |||||||||
| NPI: | 1891771481 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANGELS OF MERCY HOME HEALTH CARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ANGELS OF MERCY HOMECARE PLUS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 N WABASH RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MARION | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469521300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656513242 | ||||||||
| FaxNumber: | 7656513246 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 N WABASH RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MARION | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469521300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656513242 | ||||||||
| FaxNumber: | 7656513246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 01/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | KELLY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER, CEO | ||||||||
| AuthorizedOfficialTelephone: | 4059282727 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 003890 | IN | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 003890 | 01 | IN | ISBH LICENSE NUMBER | OTHER |