Healthcare Provider Details

I. General information

NPI: 1821917626
Provider Name (Legal Business Name): GRACEFUL MANAGEMENT CARE SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 PAXMORE CT
UPPER MARLBORO MD
20772-7700
US

IV. Provider business mailing address

3704 PAXMORE CT
UPPER MARLBORO MD
20772-7700
US

V. Phone/Fax

Practice location:
  • Phone: 240-828-0605
  • Fax:
Mailing address:
  • Phone: 240-828-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TASHANNA YANNECA WHITTON
Title or Position: OWNER
Credential: ADMINISTRATOR
Phone: 240-828-0605