Provider Demographics
NPI:1558107177
Name:MERCY HOMECARE SERVICE LLC
Entity type:Organization
Organization Name:MERCY HOMECARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYICHOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-987-1742
Mailing Address - Street 1:11015 OKINAWA ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6205
Mailing Address - Country:US
Mailing Address - Phone:612-987-1742
Mailing Address - Fax:
Practice Address - Street 1:11015 OKINAWA ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-6205
Practice Address - Country:US
Practice Address - Phone:612-987-1742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health