Healthcare Provider Details

I. General information

NPI: 1821834987
Provider Name (Legal Business Name): HOUSE OF MERCY HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 01/31/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 RIDGE RD STE 2
ROSEDALE MD
21237-3960
US

IV. Provider business mailing address

6700 RIDGE RD STE 2
ROSEDALE MD
21237-3960
US

V. Phone/Fax

Practice location:
  • Phone: 410-746-0088
  • Fax:
Mailing address:
  • Phone: 410-746-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMADI NWOKOCHA
Title or Position: DIRECTOR
Credential:
Phone: 443-355-1861