MEDICARE: ANGELS OF MERCY HOME HEALTH CARE, 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	HC7359	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HC7359	OTHER	OK	STATE LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619973435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS OF MERCY HOME HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 461
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-0461
Country	:	US
Telephone Number	:	580-772-1003
Fax Number	:	580-772-0298

Provider Business Practice Location Address
First Line	:	914 E HIGHLAND AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-4617
Country	:	US
Telephone Number	:	580-765-9241
Fax Number	:	580-765-5871

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ANITA J MERIDA
Credential	:
Telephone Number	:	580-772-1003

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	08/31/2010

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