Healthcare Provider Details

I. General information

NPI: 1013990704
Provider Name (Legal Business Name): MERCY TYLER HOME HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 SR 6 W
TUNKHANNOCK PA
18657-6149
US

IV. Provider business mailing address

880 SR 6 W
TUNKHANNOCK PA
18657-6149
US

V. Phone/Fax

Practice location:
  • Phone: 570-836-1640
  • Fax: 570-836-6415
Mailing address:
  • Phone: 570-836-1640
  • Fax: 570-836-6415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number757005
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5260031
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA PROVIDER #
# 2
Identifier1526558
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGATEWAY HLTH PLN PROV #
# 3
Identifier397570
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBC ACCESS CARE II PROV#
# 4
Identifier397570
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE CROSS OF NEPA PROV#
# 5
Identifier080381
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY HLTH PROV#
# 6
Identifier117925
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerTHREE RIVERS HLTH PROV#
# 7
Identifier0014335270002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 8
Identifier30868
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER HLTH PLN PRVDR#

VIII. Authorized Official

Name: STEPHEN H FRANKO
Title or Position: CFO
Credential:
Phone: 570-348-7074