Healthcare Provider Details

I. General information

NPI: 1386863538
Provider Name (Legal Business Name): GRACE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 OLD COURT RD
RANDALLSTOWN MD
21133-5100
US

IV. Provider business mailing address

5400 OLD COURT RD
RANDALLSTOWN MD
21133-5100
US

V. Phone/Fax

Practice location:
  • Phone: 410-383-5101
  • Fax: 410-383-4513
Mailing address:
  • Phone: 410-362-3000
  • Fax: 410-383-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE BERKLEY-BROWN
Title or Position: AVP OPERATIONS
Credential:
Phone: 410-362-3378