Healthcare Provider Details

I. General information

NPI: 1003802596
Provider Name (Legal Business Name): MERCY MEMORIAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 CLEVELAND AVE
STEVENSVILLE MI
49127-9595
US

IV. Provider business mailing address

PO BOX 410
SAINT JOSEPH MI
49085-0410
US

V. Phone/Fax

Practice location:
  • Phone: 269-983-6501
  • Fax: 269-983-2237
Mailing address:
  • Phone: 269-983-6501
  • Fax: 269-983-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number114130
License Number StateMI

VIII. Authorized Official

Name: MATTHEW E COX
Title or Position: CFO
Credential:
Phone: 616-391-1663