Provider Demographics
NPI:1154420909
Name:MERCY CARE INC.
Entity type:Organization
Organization Name:MERCY CARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WHITTED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-385-6559
Mailing Address - Street 1:218 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-3208
Mailing Address - Country:US
Mailing Address - Phone:910-385-6559
Mailing Address - Fax:910-590-5151
Practice Address - Street 1:415 WARSAW RD STE B
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3550
Practice Address - Country:US
Practice Address - Phone:910-385-6559
Practice Address - Fax:910-592-4728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 253Z00000X
NCMHL-082-060320600000X
NCMHL-082-079320900000X
NC311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No251S00000XAgenciesCommunity/Behavioral Health
Yes253Z00000XAgenciesIn Home Supportive Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418438Medicaid