Provider Demographics
NPI:1972489037
Name:MERCY OF GOD LLC
Entity type:Organization
Organization Name:MERCY OF GOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAYE
Authorized Official - Middle Name:O
Authorized Official - Last Name:DODO-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-996-2400
Mailing Address - Street 1:13671 REGIS DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-2500
Mailing Address - Country:US
Mailing Address - Phone:909-996-2400
Mailing Address - Fax:
Practice Address - Street 1:13671 REGIS DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-2500
Practice Address - Country:US
Practice Address - Phone:909-996-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility