Healthcare Provider Details

I. General information

NPI: 1407648108
Provider Name (Legal Business Name): MERCY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9012 TESSMAN PKWY N
BROOKLYN PARK MN
55445
US

IV. Provider business mailing address

9012 TESSMAN PKWY N
BROOKLYN PARK MN
55445
US

V. Phone/Fax

Practice location:
  • Phone: 763-269-9996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: UBAH KHAIREH
Title or Position: CEO/OPERATOR
Credential:
Phone: 763-269-9996