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General NPI Number Information
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NPI Number | 1104159839
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Entity Type | Organization
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Legal Business Name | PEACE & GLORY MANOR, INC
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 3829 KILBURN RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-4655
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Country | US
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Telephone | 443-389-9959
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Fax | 410-922-4620
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Provider Business Mailing Address
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Address Line | 3829 KILBURN RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-4655
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Country | US
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Telephone | 443-386-9959
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Fax | 410-922-4620
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Authorized Official
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Title or Position | OWNER
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Name | MS. GLORIA LYNN BROWN - BRISTOL
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Credential |
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Telephone | 443-386-9959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207ZB0001X
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Taxonomy Name | Blood Banking & Transfusion Medicine Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 208U00000X
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Taxonomy Name | Clinical Pharmacology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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Taxonomy #8
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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Taxonomy #9
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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Taxonomy #12
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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Taxonomy #13
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #14
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #15
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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