MEDICARE: MERCY CARE CORP

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	103TM1800X	Intellectual & Developmental Disabilities Psychologist

General Provider Information

NPI Number	:	1780412627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY CARE CORP

Provider Business Mailing Address
First Line	:	PO BOX 1782
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-0660
Country	:	US
Telephone Number	:	804-614-5855
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 WINDOMERE AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-2953
Country	:	US
Telephone Number	:	804-614-5855
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER/OWNER
Name	:	ALICE LOMELING
Credential	:	MBA,
Telephone Number	:	804-614-5855

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	07/23/2024

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Directions to “MERCY CARE CORP ” Practice Location

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