Organization
MERCY'S QUALITY HOME CARE, LLC300562457
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MERCY EKPOUDOM REGISTERED NURSE (NURSING ADMISTRATOR)
(678) 978-8220
Entity
Organization
Contact information
Practice address
120 NORTHBERRY ST., SUITE 101, STOCKBRIDGE, GA 30281-1093
(678) 608-7151
(678) 289-9256
Mailing address
120 NORTHBERRY ST., SUITE 101, STOCKBRIDGE, GA 30281-1093
(678) 608-7151
(678) 289-9256
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
075-R-1030
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003137788A
MEDICAID PROVIDER #
GA
01
—
003137789A
MEDICAID PROVIDER #
GA
Enumeration date
12/20/2013
Last updated
12/20/2013
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