1467588335 NPI number — MERCY CREST HOUSING, INC

Table of content: (NPI 1467588335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467588335 NPI number — MERCY CREST HOUSING, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY CREST HOUSING, 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:
Provider Other Organization Name Type Code:
6
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:
1467588335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 STROZIER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARLING
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72923-2002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-478-3000
Provider Business Mailing Address Fax Number:
479-452-8382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 STROZIER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARLING
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72923-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-478-3000
Provider Business Practice Location Address Fax Number:
479-452-8382
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRESSON
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
479-478-3000

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  014 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 147992794 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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