Healthcare Provider Details

I. General information

NPI: 1831792811
Provider Name (Legal Business Name): MERC SUPPORTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E BEAUMONT RD
COLUMBUS OH
43224-2228
US

IV. Provider business mailing address

PO BOX 2796
COLUMBUS OH
43216-2796
US

V. Phone/Fax

Practice location:
  • Phone: 614-980-4807
  • Fax:
Mailing address:
  • Phone: 614-306-1509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BLAZEK
Title or Position: CFO
Credential:
Phone: 614-306-1509