Provider Demographics
NPI:1063980464
Name:MERCY MENTAL HEALTHCARE SERVICES, INC
Entity type:Organization
Organization Name:MERCY MENTAL HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:OMOLARA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ADEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-677-7130
Mailing Address - Street 1:20 S HILTON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-3724
Mailing Address - Country:US
Mailing Address - Phone:410-415-6505
Mailing Address - Fax:410-415-6506
Practice Address - Street 1:20 S HILTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-3724
Practice Address - Country:US
Practice Address - Phone:410-415-6505
Practice Address - Fax:410-415-6506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBH001341Medicaid