MEDICARE: MERCY HOME HEALTH CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	PCA 275	WI

General Provider Information

NPI Number	:	1164879557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	1672 S 9TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3426
Country	:	US
Telephone Number	:	414-217-3651
Fax Number	:	414-616-1499

Provider Business Practice Location Address
First Line	:	1672 S 9TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3426
Country	:	US
Telephone Number	:	414-217-3651
Fax Number	:	414-616-1499

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ABDIKARIM A KARSHE
Credential	:
Telephone Number	:	414-217-3651

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	05/16/2016

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