Provider Demographics
NPI:1871796789
Name:MERCY HOSPICE, LLC
Entity type:Organization
Organization Name:MERCY HOSPICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:732-792-1200
Mailing Address - Street 1:2430 STATE HIGHWAY 34
Mailing Address - Street 2:SUITE A-22
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736
Mailing Address - Country:US
Mailing Address - Phone:732-528-2200
Mailing Address - Fax:732-528-2299
Practice Address - Street 1:2430 STATE HIGHWAY 34
Practice Address - Street 2:SUITE A-22
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-528-2200
Practice Address - Fax:732-528-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ311570Medicare Oscar/Certification