Healthcare Provider Details

I. General information

NPI: 1144124512
Provider Name (Legal Business Name): GRACE RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3743 DONNELL DR APT 304
DISTRICT HEIGHTS MD
20747-3922
US

IV. Provider business mailing address

3743 DONNELL DR APT 304
DISTRICT HEIGHTS MD
20747-3922
US

V. Phone/Fax

Practice location:
  • Phone: 240-795-8661
  • Fax:
Mailing address:
  • Phone: 240-795-8661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHACONDA BURRELL
Title or Position: MS
Credential:
Phone: 240-795-8661