Healthcare Provider Details

I. General information

NPI: 1134800055
Provider Name (Legal Business Name): MERCY STAFFING AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4406 REVEREND DAVIS DR
UPPER MARLBORO MD
20772-6977
US

IV. Provider business mailing address

4406 REVEREND DAVIS DR
UPPER MARLBORO MD
20772-6977
US

V. Phone/Fax

Practice location:
  • Phone: 240-353-8509
  • Fax:
Mailing address:
  • Phone: 240-353-8509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: OLUWASEUN Y OKUNOREN
Title or Position: MANAGER
Credential:
Phone: 240-353-8509