Healthcare Provider Details

I. General information

NPI: 1679492110
Provider Name (Legal Business Name): NEW MERCY RESIDENCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 STUART ST
CHATTANOOGA TN
37406-1858
US

IV. Provider business mailing address

2107 STUART ST
CHATTANOOGA TN
37406-1858
US

V. Phone/Fax

Practice location:
  • Phone: 347-475-5265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: OLUTOPE CRAFT
Title or Position: DIRECTOR
Credential:
Phone: 347-475-5265