Provider Demographics
NPI:1154317048
Name:MERCY COMMUNITY HOMECARE SERVICES, INC
Entity type:Organization
Organization Name:MERCY COMMUNITY HOMECARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEAULIEU
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:860-570-8304
Mailing Address - Street 1:275 STEELE ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2755
Mailing Address - Country:US
Mailing Address - Phone:860-586-8318
Mailing Address - Fax:860-586-8418
Practice Address - Street 1:2021 ALBANY AVENUE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117
Practice Address - Country:US
Practice Address - Phone:860-586-8318
Practice Address - Fax:860-586-8418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC9815005251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004188274Medicaid
CT4113776OtherCCCI
CT044188274Medicaid
CT004188274Medicaid
CT4113776OtherCCCI