Healthcare Provider Details

I. General information

NPI: 1720308059
Provider Name (Legal Business Name): MERRYCARE HOME ASSISTANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 W H ST
ELIZABETHTON TN
37643-2923
US

IV. Provider business mailing address

712 W H ST
ELIZABETHTON TN
37643-2923
US

V. Phone/Fax

Practice location:
  • Phone: 423-542-6997
  • Fax: 423-543-5651
Mailing address:
  • Phone: 423-542-6997
  • Fax: 423-543-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ADAM DOUGLAS MERRYMAN
Title or Position: CO-OWNER, DIR OF OPERATIONS
Credential: B.S.
Phone: 423-542-6997