Provider Demographics
NPI:1003149733
Name:PEACE & GLORY MANOR, INC
Entity Type:Organization
Organization Name:PEACE & GLORY MANOR, INC
Other - Org Name:PEACE & GLORY MANOR MEDICAL ADULT & SENIOR PLUS DAYCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROWN - BRISTOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-386-9959
Mailing Address - Street 1:3829 KILBURN RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4655
Mailing Address - Country:US
Mailing Address - Phone:443-386-9959
Mailing Address - Fax:410-922-4620
Practice Address - Street 1:3829 KILBURN RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4655
Practice Address - Country:US
Practice Address - Phone:443-386-9959
Practice Address - Fax:410-922-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No291U00000XLaboratoriesClinical Medical Laboratory
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332S00000XSuppliersHearing Aid Equipment
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle