MEDICARE: MERCY RIDGE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	03AL694-H	MD

General Provider Information

NPI Number	:	1083987416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY RIDGE, INC

Provider Business Mailing Address
First Line	:	2525 POT SPRING RD
Second Line	:
City	:	TIMONIUM
State	:	MD
Zip	:	21093-2778
Country	:	US
Telephone Number	:	410-561-0200
Fax Number	:	410-561-0400

Provider Business Practice Location Address
First Line	:	2525 POT SPRING RD
Second Line	:
City	:	TIMONIUM
State	:	MD
Zip	:	21093-2778
Country	:	US
Telephone Number	:	410-561-0200
Fax Number	:	410-561-0400

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. CONSTANCE MARIE SMITH
Credential	:	RN
Telephone Number	:	410-308-9486

Provider Enumeration Date	:	02/15/2012
Last Update Date	:	02/15/2012

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