Basic Information
| Provider Information | |||||||||
| NPI: | 1902481658 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCY PLUS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 623 W WARWICK DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488011177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9892851490 | ||||||||
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| Practice Location | |||||||||
| Address1: | 623 W WARWICK DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488011177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9892851490 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2021 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | DANIELLE | ||||||||
| AuthorizedOfficialMiddleName: | LEIGH | ||||||||
| AuthorizedOfficialTitleorPosition: | BEHAVIOR TECHNICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9893889277 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | NA | 05 | MI | MEDICAID |