Healthcare Provider Details

I. General information

NPI: 1023804861
Provider Name (Legal Business Name): GRACE HEALING WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8527 RHUDDLAN RD
NOTTINGHAM MD
21236-2623
US

IV. Provider business mailing address

8527 RHUDDLAN RD
NOTTINGHAM MD
21236-2623
US

V. Phone/Fax

Practice location:
  • Phone: 443-377-4672
  • Fax:
Mailing address:
  • Phone: 443-377-4672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RAPHAEL GIKONYO
Title or Position: PRESIDENT
Credential:
Phone: 443-377-4672