MEDICARE: MERCY VISIONS HOME HEALTHCARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		MO
2	253Z00000X	In Home Supportive Care Agency		MO

General Provider Information

NPI Number	:	1033450077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY VISIONS HOME HEALTHCARE INC

Provider Business Mailing Address
First Line	:	3221 DOMAIN ST APT 1
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-8301
Country	:	US
Telephone Number	:	636-294-5089
Fax Number	:	636-614-0766

Provider Business Practice Location Address
First Line	:	3221 DOMAIN ST APT 1
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-8301
Country	:	US
Telephone Number	:	636-294-5089
Fax Number	:	636-614-0766

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. TERRELL LYNN SIMMS
Credential	:
Telephone Number	:	636-294-5089

Provider Enumeration Date	:	03/14/2013
Last Update Date	:	03/14/2013

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