Provider Demographics
NPI:1215079165
Name:ANGELS OF MERCY HOME HEALTH CARE INC
Entity type:Organization
Organization Name:ANGELS OF MERCY HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MANIKA
Authorized Official - Middle Name:HAZEL
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-348-2603
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NC
Mailing Address - Zip Code:27849-0639
Mailing Address - Country:US
Mailing Address - Phone:252-348-2603
Mailing Address - Fax:
Practice Address - Street 1:120 EAST CHURCH STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NC
Practice Address - Zip Code:27849
Practice Address - Country:US
Practice Address - Phone:252-348-2603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1433251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601097Medicaid