NPIMap

Organization Active NPI

Mercy'S Quality Home Care, Llc300562457

  • Pediatric Skilled Nursing Facility
  • Stockbridge, GA
National Provider Identifier
1053732842
Registry record updated Dec 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Skilled Nursing FacilityTaxonomy code 3140N1450X
License
075-R-1030 Issued in GA
Legal business name
MERCY'S QUALITY HOME CARE, LLC300562457
Practice address
120 Northberry St.
Suite 101
Stockbridge, GA 30281-1093
Phone
(678) 608-7151
Fax
(678) 289-9256
NPI assigned
Dec 20, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Mercy Ekpoudom, REGISTERED NURSE
Title
Nursing Admistrator
Phone
(678) 978-8220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Skilled Nursing Facility 3140N1450X 075-R-1030 GA Primary

Addresses

Primary practice location

120 Northberry St.
Suite 101
Stockbridge, GA 30281-1093

Mailing address

120 Northberry St.
Suite 101
Stockbridge, GA 30281-1093
Phone (678) 608-7151

Other identifiers 2

IdentifierTypeStateIssuer
003137789AOtherGAMEDICAID PROVIDER #
003137788AOtherGAMEDICAID PROVIDER #

National Provider Directory

National Provider Directory
Tax ID family
Mercy'S Quality Home Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1387497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387497600000",
    "number": "1053732842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 NORTHBERRY ST.",
            "address_2": "SUITE 101",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302811093",
            "telephone_number": "678-608-7151",
            "fax_number": "678-289-9256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 NORTHBERRY ST.",
            "address_2": "SUITE 101",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302811093",
            "telephone_number": "678-608-7151",
            "fax_number": "678-289-9256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY'S QUALITY HOME CARE, LLC300562457",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-20",
        "last_updated": "2013-12-20",
        "status": "A",
        "authorized_official_last_name": "EKPOUDOM",
        "authorized_official_first_name": "MERCY",
        "authorized_official_title_or_position": "NURSING ADMISTRATOR",
        "authorized_official_telephone_number": "678-978-8220",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "REGISTERED NURSE"
    },
    "taxonomies": [
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": "GA",
            "license": "075-R-1030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PROVIDER #",
            "identifier": "003137789A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PROVIDER #",
            "identifier": "003137788A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.