Provider Demographics
NPI:1548004393
Name:HOUSE OF MERCY HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:HOUSE OF MERCY HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AMADI
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-355-1861
Mailing Address - Street 1:5004 HONEYGO CENTER DR STE 102-307
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-8963
Mailing Address - Country:US
Mailing Address - Phone:410-746-0088
Mailing Address - Fax:
Practice Address - Street 1:5004 HONEYGO CENTER DR STE 102-307
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-8963
Practice Address - Country:US
Practice Address - Phone:410-746-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty