Healthcare Provider Details

I. General information

NPI: 1548359441
Provider Name (Legal Business Name): MERCY SERVICES FOR AGING NONPROFIT HOUSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

873 W AVON RD
ROCHESTER HILLS MI
48307-2705
US

IV. Provider business mailing address

PO BOX 9184
FARMINGTON HILLS MI
48333-9184
US

V. Phone/Fax

Practice location:
  • Phone: 248-656-3239
  • Fax: 248-656-3269
Mailing address:
  • Phone: 248-305-7919
  • Fax: 348-305-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number634018
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JACKIE HARRIS
Title or Position: CEO
Credential:
Phone: 248-305-7688