Healthcare Provider Details

I. General information

NPI: 1942354873
Provider Name (Legal Business Name): MERCY MEMORIAL HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 STEWART RD STE 105
MONROE MI
48162-5304
US

IV. Provider business mailing address

718 N MACOMB ST
MONROE MI
48162
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-1770
  • Fax: 734-240-1780
Mailing address:
  • Phone: 734-240-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number580030
License Number StateMI

VIII. Authorized Official

Name: LARRY CSOKASY
Title or Position: MENTAL HEALTH SERVICES DIRECTOR
Credential: LMSW
Phone: 734-240-1770