Healthcare Provider Details

I. General information

NPI: 1114844909
Provider Name (Legal Business Name): MERCY CARE SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5696 UTRECHT RD
BALTIMORE MD
21206-2905
US

IV. Provider business mailing address

5696 UTRECHT RD
BALTIMORE MD
21206-2905
US

V. Phone/Fax

Practice location:
  • Phone: 443-825-9875
  • Fax:
Mailing address:
  • Phone: 443-825-9875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BENDU JACKSON
Title or Position: CEO
Credential: RN
Phone: 443-825-9875