Mercy Home Assisted Living Facility LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12314 Issued in FL

Legal business name

MERCY HOME ASSISTED LIVING FACILITY LLC

Practice address

184 S.E. Beech Street
Lake City, FL 32025

Phone

(386) 487-5029

Fax

(386) 487-5029

NPI assigned

Oct 8, 2014

Organization subpart

No

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

Authorized official

Name

Mrs. Clara Lee FergusonNPI 1366866097

Title

Administrator/Owner

Phone

(386) 487-5029

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Clara Ferguson I

  • Assisted Living Facility
  • Lake City, FL
  • NPI 1366866097
  NPD (past) Authorized official

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

{
    "created_epoch": "1412726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413158400000",
    "number": "1306249149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "184 S.E. BEECH STREET",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "32025",
            "telephone_number": "386-487-5029",
            "fax_number": "386-487-5029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "184 S.E. BEECH STREET",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "32025",
            "telephone_number": "386-487-5029",
            "fax_number": "386-487-5029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOME ASSISTED LIVING FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-08",
        "last_updated": "2014-10-13",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "CLARA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "ADMINISTRATOR/OWNER",
        "authorized_official_telephone_number": "386-487-5029",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009258500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah E Mehalko
• Shivani Mehta, PHARMD
• Melanie Holden, DMD, PLLC
• Matthew Neil Melvin, ARNP
• Grace Elbo Mercurio, A.R.N.P.
• Mercy Medical Urgent Care Center
• Meridan Behavioral Healthcare
• Meridian Behavioral Healthcare
• Meridian Behavioral Healthcare Inc.
• Meridian Behavioral Healthcare, Inc of Lake City

• Assisted Living Facility in Lake City, FL
• Providers in Lake City, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; 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.