Mercy Long Term Care Initiatives, Inc.

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

Legal business name

MERCY LONG TERM CARE INITIATIVES, INC.

Doing business as

Providence Retirement Home

Practice address

4915 Charlestown Rd
New Albany, IN 47150-9426

Phone

(812) 945-5221

Fax

(812) 945-2614

NPI assigned

Sep 30, 2005

Organization subpart

No

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

Authorized official

Name

Mr. William Robert Lee, CPA

Title

Cfo

Phone

(812) 945-5221

Specialties & licenses 1

Addresses

Other names 1

• Providence Retirement Home Doing business as

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992792303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4915 CHARLESTOWN RD",
            "city": "NEW ALBANY",
            "state": "IN",
            "postal_code": "471509426",
            "telephone_number": "812-945-5221",
            "fax_number": "812-945-2614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4915 CHARLESTOWN RD",
            "city": "NEW ALBANY",
            "state": "IN",
            "postal_code": "471509426",
            "telephone_number": "812-945-5221",
            "fax_number": "812-945-2614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY LONG TERM CARE INITIATIVES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "812-945-5221",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Retirement Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nursing Facility/Intermediate Care Facility in New Albany, IN
• Providers in New Albany, IN by specialty
• Nursing Facility/Intermediate Care Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.