Provider Demographics
NPI:1700118064
Name:MERCY NURSINGCARE SERVICES
Entity Type:Organization
Organization Name:MERCY NURSINGCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.N./D.O.N.
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:ABONANJAH
Authorized Official - Last Name:NDUMBI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-537-8328
Mailing Address - Street 1:6408 LAMONT DR
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3318
Mailing Address - Country:US
Mailing Address - Phone:301-537-8328
Mailing Address - Fax:240-477-2407
Practice Address - Street 1:6408 LAMONT DR
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3318
Practice Address - Country:US
Practice Address - Phone:301-537-8328
Practice Address - Fax:240-477-2407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD55640008-00Medicaid