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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
1251B00000XCase Management Agency
2302R00000XHealth Maintenance OrganizationMD
33104A0625XAssisted Living Facility (Mental Illness)
43104A0630XAssisted Living Facility (Behavioral Disturbances)
5314000000XSkilled Nursing Facility
6343900000XNon-emergency Medical Transport (VAN)
7347B00000XBusMD
8347C00000XPrivate Vehicle
9310400000XAssisted Living Facility

General Provider Information

NPI Number : 1952636649
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 : 410-922-2617
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 : 410-922-2617
Fax Number : 410-922-4620
Authorized Official
Title or Position : FOUNDER CEO, PRESIDENT
Name : MS. GLORIA LYNN BROWN - BRISTOL
Credential :
Telephone Number : 410-922-2617
Provider Enumeration Date : 10/13/2009
Last Update Date : 10/13/2009

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

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