Healthcare Provider Details

I. General information

NPI: 1841763562
Provider Name (Legal Business Name): MERCY HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 ELLICOTT CENTER DR STE 102
ELLICOTT CITY MD
21043-4157
US

IV. Provider business mailing address

3460 ELLICOTT CENTER DR STE 102
ELLICOTT CITY MD
21043-4157
US

V. Phone/Fax

Practice location:
  • Phone: 410-465-3074
  • Fax: 410-220-0661
Mailing address:
  • Phone: 410-465-3074
  • Fax: 410-220-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEA SUB SONG
Title or Position: DIRECTOR
Credential: D.C.
Phone: 410-465-3074