Healthcare Provider Details

I. General information

NPI: 1285540633
Provider Name (Legal Business Name): A PLACE OF GRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W EAGER ST STE 400B
BALTIMORE MD
21201-5471
US

IV. Provider business mailing address

10 W EAGER ST STE 400B
BALTIMORE MD
21201-5471
US

V. Phone/Fax

Practice location:
  • Phone: 443-722-6838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TARA BOWSER
Title or Position: CEO
Credential: BOWSER
Phone: 443-722-6838