1205821816 NPI number — MERCY AMICARE HOME HEALTHCARE, PORT HURON

Table of content: (NPI 1205821816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205821816 NPI number — MERCY AMICARE HOME HEALTHCARE, PORT HURON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY AMICARE HOME HEALTHCARE, PORT HURON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. JOSEPH MERCY HOME CARE, PORT HURON
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205821816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 9185
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48333-9185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-542-8220
Provider Business Mailing Address Fax Number:
734-542-8286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 HURON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT HURON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48060-3805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-966-3040
Provider Business Practice Location Address Fax Number:
810-966-3055
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SEARS
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACT ANALYST
Authorized Official Telephone Number:
734-542-8279

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3376644 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: OE134 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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