MEDICARE: MERCY CARES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	3104A0625X	Assisted Living Facility (Mental Illness)
3	320800000X	Mental Illness Community Based Residential Treatment Facility
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
5	323P00000X	Psychiatric Residential Treatment Facility
6	324500000X	Substance Abuse Rehabilitation Facility
7	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1386242295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY CARES LLC

Provider Business Mailing Address
First Line	:	2644 E PARADISE LN APT D
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2945
Country	:	US
Telephone Number	:	503-593-6859
Fax Number	:

Provider Business Practice Location Address
First Line	:	2644 E PARADISE LN APT D
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2945
Country	:	US
Telephone Number	:	503-593-6859
Fax Number	:

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	MAHAMED FARAH
Credential	:
Telephone Number	:	503-593-6859

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	10/13/2020

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