1003058967 NPI number — SAINT JOSEPH'S MERCY CARE SERVICES, INC.

Table of content: (NPI 1003058967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003058967 NPI number — SAINT JOSEPH'S MERCY CARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT JOSEPH'S MERCY CARE SERVICES, INC.
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:
SAINT JOSEPH'S MERCY CARE - MARY HALL FREEDOM HOUSE
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:
1003058967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 DECATUR ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30312-1848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-843-8600
Provider Business Mailing Address Fax Number:
678-843-8601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 HANNOVER PARK RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30350-1899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-843-8500
Provider Business Practice Location Address Fax Number:
678-843-8601
Provider Enumeration Date:
03/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREWS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
678-843-8503

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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