Healthcare Provider Details

I. General information

NPI: 1427272012
Provider Name (Legal Business Name): MERCER COUNTY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4871 STATE ROUTE 29
CELINA OH
45822-8216
US

IV. Provider business mailing address

4871 STATE ROUTE 29
CELINA OH
45822-8216
US

V. Phone/Fax

Practice location:
  • Phone: 419-586-5513
  • Fax: 419-586-5577
Mailing address:
  • Phone: 419-586-5513
  • Fax: 419-586-5577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY L. MOEDER
Title or Position: ADMINISTRATOR
Credential: LNH
Phone: 419-586-5513