Healthcare Provider Details

I. General information

NPI: 1548452121
Provider Name (Legal Business Name): MERRICK COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 EDGERTON ST
SAINT PAUL MN
55130-4549
US

IV. Provider business mailing address

1526 6TH ST E
SAINT PAUL MN
55106-4806
US

V. Phone/Fax

Practice location:
  • Phone: 651-771-9339
  • Fax: 651-771-8465
Mailing address:
  • Phone: 651-771-8821
  • Fax: 651-771-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANCIS IVORY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 651-771-8821