Provider Demographics
NPI:1538598735
Name:MERCY CARE PROVIDERS, LLC
Entity type:Organization
Organization Name:MERCY CARE PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:I
Authorized Official - Last Name:LIKAMBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-538-0207
Mailing Address - Street 1:4804 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2943
Mailing Address - Country:US
Mailing Address - Phone:301-260-1777
Mailing Address - Fax:
Practice Address - Street 1:10015 OLD COLUMBIA RD STE B215
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1865
Practice Address - Country:US
Practice Address - Phone:410-309-7052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 253Z00000X, 320900000X, 261QD1600X
MDR34463140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities