Provider Demographics
NPI:1972598290
Name:OUR LADY OF MERCY LIFE CENTER
Entity type:Organization
Organization Name:OUR LADY OF MERCY LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:I
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-464-8100
Mailing Address - Street 1:2 MERCYCARE LN
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-3505
Mailing Address - Country:US
Mailing Address - Phone:518-464-8100
Mailing Address - Fax:518-464-8111
Practice Address - Street 1:2 MERCYCARE LN
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084-3505
Practice Address - Country:US
Practice Address - Phone:518-464-8100
Practice Address - Fax:518-464-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0155301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01417409Medicaid
NY335767Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NY54255AMedicare PIN