MEDICARE: GRAMPS ASSISTED LIVING

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
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1700543105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAMPS ASSISTED LIVING

Provider Business Mailing Address
First Line	:	3140 LEEDS ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-3817
Country	:	US
Telephone Number	:	443-802-1117
Fax Number	:	443-708-2991

Provider Business Practice Location Address
First Line	:	3140 LEEDS ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-3817
Country	:	US
Telephone Number	:	443-802-1117
Fax Number	:	443-708-2991

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	DENISE VANITA WALKER
Credential	:
Telephone Number	:	443-802-1117

Provider Enumeration Date	:	11/19/2021
Last Update Date	:	11/19/2021

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Directions to “GRAMPS ASSISTED LIVING ” Practice Location

Language	Start Address	Practice Location

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