MEDICARE: MERCYFULL HOME HEALTH INC,

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		PA

General Provider Information

NPI Number	:	1538406988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCYFULL HOME HEALTH INC,

Provider Business Mailing Address
First Line	:	1733 SPRING GARDEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3915
Country	:	US
Telephone Number	:	267-639-2706
Fax Number	:	267-639-2699

Provider Business Practice Location Address
First Line	:	1733 SPRING GARDEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3915
Country	:	US
Telephone Number	:	267-639-2706
Fax Number	:	267-639-2699

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MERCY GRANT
Credential	:	RN
Telephone Number	:	713-320-7658

Provider Enumeration Date	:	01/04/2013
Last Update Date	:	01/04/2013

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