Healthcare Provider Details

I. General information

NPI: 1952014375
Provider Name (Legal Business Name): SERENITY AND GRACE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 09/21/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W MULBERRY ST STE 400
BALTIMORE MD
21201-3606
US

IV. Provider business mailing address

110 W MULBERRY ST STE 400
BALTIMORE MD
21201-3606
US

V. Phone/Fax

Practice location:
  • Phone: 347-456-4647
  • Fax:
Mailing address:
  • Phone: 347-456-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JOHN LEE
Title or Position: CEO
Credential:
Phone: 347-456-4647