Healthcare Provider Details

I. General information

NPI: 1790701340
Provider Name (Legal Business Name): HOUSE OF MERCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 MARTIN LUTHER KING DR
VILLE PLATTE LA
70586-4833
US

IV. Provider business mailing address

1021 MARTIN LUTHER KING DRIVE
VILLE PLATTE LA
70586
US

V. Phone/Fax

Practice location:
  • Phone: 337-363-4521
  • Fax: 337-363-4524
Mailing address:
  • Phone: 337-363-4521
  • Fax: 337-363-4524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6581
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number6113
License Number StateLA

VIII. Authorized Official

Name: MR. KERNEY THOMAS SR.
Title or Position: CEO
Credential:
Phone: 337-363-4521