Provider Demographics
NPI:1083987416
Name:MERCY RIDGE, INC
Entity Type:Organization
Organization Name:MERCY RIDGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-308-9486
Mailing Address - Street 1:2525 POT SPRING RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2778
Mailing Address - Country:US
Mailing Address - Phone:410-561-0200
Mailing Address - Fax:410-561-0400
Practice Address - Street 1:2525 POT SPRING RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2778
Practice Address - Country:US
Practice Address - Phone:410-561-0200
Practice Address - Fax:410-561-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03AL694-H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility