Provider Demographics
NPI:1902966278
Name:MERCY HEALTHCARE, INC.
Entity type:Organization
Organization Name:MERCY HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVE LYN
Authorized Official - Middle Name:JUANITA
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-469-0102
Mailing Address - Street 1:42 4 SEASONSSHOP CTR
Mailing Address - Street 2:SUITE 132
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3195
Mailing Address - Country:US
Mailing Address - Phone:314-469-0102
Mailing Address - Fax:314-469-0104
Practice Address - Street 1:42 4 SEASONSSHOP CTR
Practice Address - Street 2:SUITE 132
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3195
Practice Address - Country:US
Practice Address - Phone:314-469-0102
Practice Address - Fax:314-469-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health