=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134352909
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABUNDANT GRACE HEALTH CARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2009
-----------------------------------------------------
Last Update Date | 08/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8629 LIBERTY RD SUITE D
-----------------------------------------------------
City | RANDALLSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21133-4713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-496-5027
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8629 LIBERTY RD SUITE D
-----------------------------------------------------
City | RANDALLSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21133-4713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-496-5027
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | SUBIRA ADAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-496-5027
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | R1186
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------