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General NPI Number Information
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NPI Number | 1023295789
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Entity Type | Organization
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Legal Business Name | NOVAS MERCY CARE AGENCY
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 113 W FULLER ST
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City | DAVENPORT
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State | FL
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Zip | 33837-3132
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Country | US
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Telephone | 863-421-0737
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Fax |
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Provider Business Mailing Address
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Address Line | 113 W FULLER ST
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City | DAVENPORT
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State | FL
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Zip | 33837-3132
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Country | US
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Telephone | 863-421-0737
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARY ANN HALL
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Credential |
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Telephone | 863-421-0737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 230343
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License Number State | FL
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