Healthcare Provider Details

I. General information

NPI: 1255838967
Provider Name (Legal Business Name): LADY OF MERCY HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 OLIVE RD
DAYTON OH
45426-2604
US

IV. Provider business mailing address

2222 OLIVE RD
DAYTON OH
45426-2604
US

V. Phone/Fax

Practice location:
  • Phone: 937-546-4590
  • Fax:
Mailing address:
  • Phone: 937-546-4590
  • Fax: 937-854-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MUSTAFA HUSSEIN
Title or Position: OWNER
Credential:
Phone: 937-546-4590