Provider Demographics
NPI:1053732842
Name:MERCY'S QUALITY HOME CARE, LLC300562457
Entity type:Organization
Organization Name:MERCY'S QUALITY HOME CARE, LLC300562457
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING ADMISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:EKPOUDOM
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:678-978-8220
Mailing Address - Street 1:120 NORTHBERRY ST.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-1093
Mailing Address - Country:US
Mailing Address - Phone:678-608-7151
Mailing Address - Fax:678-289-9256
Practice Address - Street 1:120 NORTHBERRY ST.
Practice Address - Street 2:SUITE 101
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-1093
Practice Address - Country:US
Practice Address - Phone:678-608-7151
Practice Address - Fax:678-289-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075-R-10303140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137789AOtherMEDICAID PROVIDER #
GA003137788AOtherMEDICAID PROVIDER #