Healthcare Provider Details

I. General information

NPI: 1427833367
Provider Name (Legal Business Name): BY GRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 E PATAPSCO AVE
BALTIMORE MD
21225-2229
US

IV. Provider business mailing address

PO BOX 2727
BALTIMORE MD
21225-0727
US

V. Phone/Fax

Practice location:
  • Phone: 410-355-3711
  • Fax:
Mailing address:
  • Phone: 410-355-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAMELA RENEE DUKES
Title or Position: OWNER
Credential:
Phone: 443-831-0191