MEDICARE: DIVINE MERCY, 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1629925607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE MERCY, INC.

Provider Business Mailing Address
First Line	:	1721 PENNSYLVANIA AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-3119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 E 31ST ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-3101
Country	:	US
Telephone Number	:	410-685-2830
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	MERCY JOHNSON
Credential	:
Telephone Number	:	410-685-2830

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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Directions to “DIVINE MERCY, INC. ” Practice Location

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