MEDICARE: MERCY HOME FOR CHILDREN, 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	315P00000X	Intellectual Disabilities Intermediate Care Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386813772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HOME FOR CHILDREN, INC.

Provider Business Mailing Address
First Line	:	243 PROSPECT PARK W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5807
Country	:	US
Telephone Number	:	718-832-1075
Fax Number	:	718-499-9189

Provider Business Practice Location Address
First Line	:	114 SIXTH AVENUE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-4417
Country	:	US
Telephone Number	:	718-230-0898
Fax Number	:	718-230-0954

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SR. CATHERINE CRUMLISH
Credential	:
Telephone Number	:	718-832-1075

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	02/29/2008

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