Healthcare Provider Details

I. General information

NPI: 1609789668
Provider Name (Legal Business Name): A TOUCH OF GRACE HYDRATION AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 INGLESIDE AVE
CATONSVILLE MD
21228-1722
US

IV. Provider business mailing address

4945 LOCKARD DR
OWINGS MILLS MD
21117-6178
US

V. Phone/Fax

Practice location:
  • Phone: 443-418-7338
  • Fax:
Mailing address:
  • Phone: 443-418-7338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. OLAMIDE ODETOYE
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 443-418-7338