Provider Demographics
NPI:1295305282
Name:MERCYLODGE HEALTHCARE SYSTEM LLC
Entity type:Organization
Organization Name:MERCYLODGE HEALTHCARE SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADEWUNMI
Authorized Official - Middle Name:RACHEAL
Authorized Official - Last Name:ADEWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-985-0515
Mailing Address - Street 1:18 LIBERTY PL APT 9
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18 LIBERTY PL APT 9
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2555
Practice Address - Country:US
Practice Address - Phone:443-985-0515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health