Provider Demographics
NPI:1487470050
Name:MERCY ADULT FOSTER CARE, LLC
Entity type:Organization
Organization Name:MERCY ADULT FOSTER CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EZRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLDEAMLAK
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPH
Authorized Official - Phone:617-909-2052
Mailing Address - Street 1:50 MERIDIAN ST UNIT 456
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-7020
Mailing Address - Country:US
Mailing Address - Phone:617-909-2052
Mailing Address - Fax:
Practice Address - Street 1:50 MERIDIAN ST UNIT 456
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-7020
Practice Address - Country:US
Practice Address - Phone:617-909-2052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-28
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care