Healthcare Provider Details

I. General information

NPI: 1942129291
Provider Name (Legal Business Name): MERCY LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1734 BOLTON ST BSMT
BALTIMORE MD
21217-4545
US

IV. Provider business mailing address

1734 BOLTON ST BSMT
BALTIMORE MD
21217-4545
US

V. Phone/Fax

Practice location:
  • Phone: 240-462-1707
  • Fax:
Mailing address:
  • Phone: 240-462-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: FNU NGWET UMRENE
Title or Position: PRESIDENT
Credential:
Phone: 240-462-1707