Healthcare Provider Details

I. General information

NPI: 1811294226
Provider Name (Legal Business Name): MERCY VILLA CONVENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6806 BELLONA AVE
BALTIMORE MD
21212-1219
US

IV. Provider business mailing address

6806 BELLONA AVE
BALTIMORE MD
21212-1219
US

V. Phone/Fax

Practice location:
  • Phone: 410-377-2450
  • Fax:
Mailing address:
  • Phone: 410-377-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number03-070
License Number StateMD

VIII. Authorized Official

Name: KATHY GREEN
Title or Position: PRESIDENT
Credential: RSM
Phone: 410-377-2450