Healthcare Provider Details

I. General information

NPI: 1659698124
Provider Name (Legal Business Name): GRACE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BALTIMORE ST
BALTIMORE MD
21223-1558
US

IV. Provider business mailing address

PO BOX 100631
ATLANTA GA
30384-0631
US

V. Phone/Fax

Practice location:
  • Phone: 410-362-3000
  • Fax:
Mailing address:
  • Phone: 410-362-3000
  • Fax: 301-631-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number30-007
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number30-0007
License Number StateMD

VIII. Authorized Official

Name: REBECCA ALTMAN
Title or Position: VP
Credential:
Phone: 443-924-1856