| Organization Name: | MERCY'S QUALITY HOME CARE, LLC300562457 |
| NPI Number: | 1053732842 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MERCY EKPOUDOM (NURSING ADMISTRATOR) |
| Mailing Address: | 120 Northberry St. Suite 101 Stockbridge |
| State: | GA US |
| Postal Code: | 302811093 |
| Phone Number: | 6786087151 |
| Fax Number: | 6782899256 |
| NPI Enumeration Date: | 12/20/2013 |
| NPI Last Update Date: | 12/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3140N1450X |
| License Number: | 075-R-1030 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Skilled Nursing Facility |
| Taxonomy Specialization: | Nursing Care, Pediatric |
| Taxonomy Definition: | A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment. |