Provider Demographics
NPI:1306315759
Name:MERCURY OPERATOR, LLC
Entity type:Organization
Organization Name:MERCURY OPERATOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-599-1759
Mailing Address - Street 1:285 LIBERTY ST NE STE 390
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3576
Mailing Address - Country:US
Mailing Address - Phone:917-599-1759
Mailing Address - Fax:
Practice Address - Street 1:2 BEAUMONT AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3302
Practice Address - Country:US
Practice Address - Phone:508-588-8550
Practice Address - Fax:508-587-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility