Healthcare Provider Details

I. General information

NPI: 1255762878
Provider Name (Legal Business Name): MERCY MINE HOMECARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2013
Last Update Date: 12/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BALIOL CT
GREENSBORO NC
27407-6601
US

IV. Provider business mailing address

2 BALIOL CT
GREENSBORO NC
27407-6601
US

V. Phone/Fax

Practice location:
  • Phone: 336-686-2932
  • Fax:
Mailing address:
  • Phone: 336-686-2932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC4639
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHC4639
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC4639
License Number StateNC

VIII. Authorized Official

Name: MRS. MERCY KAKHU
Title or Position: DIRECTOR
Credential:
Phone: 336-686-2932