MEDICARE: MERCY REIGNS HOMECARE SERVICES LTD.

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	251J00000X	Nursing Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3001825	OTHER	IL	DPH

General Provider Information

NPI Number	:	1518581461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY REIGNS HOMECARE SERVICES LTD.

Provider Business Mailing Address
First Line	:	3116 PRAIRIE ST
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60506-9229
Country	:	US
Telephone Number	:	630-566-9165
Fax Number	:

Provider Business Practice Location Address
First Line	:	3116 PRAIRIE ST
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60506-9229
Country	:	US
Telephone Number	:	630-566-9165
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IVO EWANG EWANE
Credential	:	MBA RN
Telephone Number	:	630-430-6118

Provider Enumeration Date	:	06/05/2020
Last Update Date	:	02/11/2021

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