Provider Demographics
NPI: | 1538914197 |
---|---|
Name: | MERCY MENTAL HEALTH & BEHAVIOR, INC. |
Entity type: | Organization |
Organization Name: | MERCY MENTAL HEALTH & BEHAVIOR, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | CHIDI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ORIAKU |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PMHNP |
Authorized Official - Phone: | 240-460-2211 |
Mailing Address - Street 1: | 5510 CHEROKEE AVE STE 300-N2 |
Mailing Address - Street 2: | |
Mailing Address - City: | ALEXANDRIA |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22312-2320 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 571-620-3815 |
Mailing Address - Fax: | 301-304-4380 |
Practice Address - Street 1: | 5510 CHEROKEE AVE STE 300-N2 |
Practice Address - Street 2: | |
Practice Address - City: | ALEXANDRIA |
Practice Address - State: | VA |
Practice Address - Zip Code: | 22312-2320 |
Practice Address - Country: | US |
Practice Address - Phone: | 571-620-3815 |
Practice Address - Fax: | 301-304-4380 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | MERCY MENTAL HEALTH & BEHAVIOR, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2024-04-18 |
Last Update Date: | 2024-04-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |