Provider Demographics
NPI:1083173553
Name:MERCEDES IN HOME CARE AGENCY, L.L.C
Entity type:Organization
Organization Name:MERCEDES IN HOME CARE AGENCY, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSBA
Authorized Official - Phone:972-366-6066
Mailing Address - Street 1:404 FLORENCIA PLZ
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-7692
Mailing Address - Country:US
Mailing Address - Phone:972-366-6066
Mailing Address - Fax:833-693-0003
Practice Address - Street 1:404 FLORENCIA PLZ
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-7692
Practice Address - Country:US
Practice Address - Phone:972-366-6066
Practice Address - Fax:833-693-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
457898OtherCERTIFY HOME HEATH, PRIMARY HOME CARE AGENCY
TX457524OtherCERTIFY HOME HEALTH AGENCY