Organization
MERCY HOME ASSISTED LIVING FACILITY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CLARA LEE FERGUSON (ADMINISTRATOR/OWNER)
(386) 487-5029
Entity
Organization
Contact information
Practice address
184 S.E. BEECH STREET, LAKE CITY, FL 32025
(386) 487-5029
(386) 487-5029
Mailing address
184 S.E. BEECH STREET, LAKE CITY, FL 32025
(386) 487-5029
(386) 487-5029
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12314
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009258500
—
FL
Enumeration date
10/08/2014
Last updated
10/13/2014
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