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General NPI Number Information
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NPI Number | 1639720832
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Entity Type | Organization
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Legal Business Name | MERCIFUL HEAVENLY HOMES
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Dates
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Enumeration Date | 09/28/2019
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Last Update Date | 09/28/2019
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Provider Practice Location Address
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Address Line | 279 TUGGIE EURE RD
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City | EURE
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State | NC
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Zip | 27935-9683
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Country | US
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Telephone | 252-287-8864
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 106
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City | SUNBURY
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State | NC
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Zip | 27979-0106
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Country | US
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Telephone | 252-287-8864
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. REBECCA CRAWFORD PARKS
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Credential |
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Telephone | 252-287-8864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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