Healthcare Provider Details

I. General information

NPI: 1083987416
Provider Name (Legal Business Name): MERCY RIDGE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 POT SPRING RD
TIMONIUM MD
21093-2778
US

IV. Provider business mailing address

2525 POT SPRING RD
TIMONIUM MD
21093-2778
US

V. Phone/Fax

Practice location:
  • Phone: 410-561-0200
  • Fax: 410-561-0400
Mailing address:
  • Phone: 410-561-0200
  • Fax: 410-561-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number03AL694-H
License Number StateMD

VIII. Authorized Official

Name: MS. CONSTANCE MARIE SMITH
Title or Position: DIRECTOR
Credential: RN
Phone: 410-308-9486