Mercyland Services LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

033-R-0564 Issued in GA

Legal business name

MERCYLAND SERVICES LLC

Practice address

4760 Austell Rd Ste 6
Austell, GA 30106-2007

Phone

(770) 574-4613

Fax

(770) 726-9783

NPI assigned

Sep 16, 2010

Last updated

Jun 15, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Miss Funmi Feyikemi Fasole, ADMINISTRATOR

Title

Owner

Phone

(770) 815-9471

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497484800000",
    "number": "1194033886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4760 AUSTELL RD ,SUITE 6",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301062007",
            "telephone_number": "770-574-4613",
            "fax_number": "770-726-9783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4760 AUSTELL RD STE 6",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301062007",
            "telephone_number": "770-574-4613",
            "fax_number": "770-726-9783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCYLAND SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-16",
        "last_updated": "2017-06-15",
        "status": "A",
        "authorized_official_last_name": "FASOLE",
        "authorized_official_first_name": "FUNMI",
        "authorized_official_middle_name": "FEYIKEMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-815-9471",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "GA",
            "license": "033-R-0564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2017; 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.