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NPI Code Detail

MEDICARE: PEACE & GLORY MANOR, INC

MEDICARE: PEACE & GLORY MANOR, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory
2305R00000XPreferred Provider Organization
3320700000XPhysical Disabilities Residential Treatment Facility
4332BC3200XCustomized Equipment (DME)
5332BN1400XNursing Facility Supplies (DME)
6332BP3500XParenteral & Enteral Nutrition Supplies (DME)
7332S00000XHearing Aid Equipment
8343900000XNon-emergency Medical Transport (VAN)
9347C00000XPrivate Vehicle
10343800000XSecured Medical Transport (VAN)

General Provider Information

NPI Number : 1003149733
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEACE & GLORY MANOR, INC
Provider Business Mailing Address
First Line : 3829 KILBURN RD
Second Line :
City : RANDALLSTOWN
State : MD
Zip : 21133-4655
Country : US
Telephone Number : 443-386-9959
Fax Number : 410-922-4620
Provider Business Practice Location Address
First Line : 3829 KILBURN RD
Second Line :
City : RANDALLSTOWN
State : MD
Zip : 21133-4655
Country : US
Telephone Number : 443-386-9959
Fax Number : 410-922-4620
Authorized Official
Title or Position : OWNER
Name : MS. GLORIA LYNN BROWN - BRISTOL
Credential :
Telephone Number : 443-386-9959
Provider Enumeration Date : 09/14/2009
Last Update Date : 09/14/2009

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Directions to “PEACE & GLORY MANOR, INC ” Practice Location

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