Healthcare Provider Details

I. General information

NPI: 1669909818
Provider Name (Legal Business Name): MERCY HOME CARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 E 146TH ST STE 220D
BURNSVILLE MN
55337
US

IV. Provider business mailing address

1020 E 146TH ST STE 220D
BURNSVILLE MN
55337-6757
US

V. Phone/Fax

Practice location:
  • Phone: 952-378-1323
  • Fax: 952-658-6798
Mailing address:
  • Phone: 952-378-1323
  • Fax: 952-658-6798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1084488-1-HCBS
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number1084488-1-HCBS
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number1084488-1-HCBS
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number1084488-1-HCBS
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1084488-1-HCBS
License Number StateMN

VIII. Authorized Official

Name: KASSIM SHEIKH MOHAMED
Title or Position: CEO
Credential:
Phone: 952-737-2945