Healthcare Provider Details

I. General information

NPI: 1104901453
Provider Name (Legal Business Name): GRACE HOME MEDICAL EQUIPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 CROMWELL PARK DR SUITE F
GLEN BURNIE MD
21061
US

IV. Provider business mailing address

540 SOUTH UNION AVENUE
HAVRE DE GRACE MD
21078
US

V. Phone/Fax

Practice location:
  • Phone: 410-939-1212
  • Fax: 410-939-5952
Mailing address:
  • Phone: 410-939-1212
  • Fax: 410-939-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK D RICHARDSON
Title or Position: PRESIDENT
Credential:
Phone: 410-939-1212