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General NPI Number Information
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NPI Number | 1558501874
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Entity Type | Organization
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Legal Business Name | ST. MERCY HOME HEALTH AGENCY, LLC.
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 6595 NW 36TH ST SUITE 101-D
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-6979
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Country | US
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Telephone | 305-871-2002
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Fax | 305-871-0004
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Provider Business Mailing Address
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Address Line | 6595 NW 36TH ST SUITE 101-D
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-6979
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Country | US
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Telephone | 305-871-2002
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Fax | 305-871-0004
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Authorized Official
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Title or Position | MGR
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Name | OTTO MARQUES
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Credential |
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Telephone | 305-871-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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