Provider Demographics
NPI:1043251341
Name:GRACE CARE LLC
Entity Type:Organization
Organization Name:GRACE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-586-3126
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:SOLOMONS
Mailing Address - State:MD
Mailing Address - Zip Code:20688-1410
Mailing Address - Country:US
Mailing Address - Phone:410-586-3126
Mailing Address - Fax:410-586-3128
Practice Address - Street 1:90 HOLIDAY DR
Practice Address - Street 2:UNIT B
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688
Practice Address - Country:US
Practice Address - Phone:410-586-3126
Practice Address - Fax:410-586-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000747100Medicaid
DC036311700Medicaid
DC036311700Medicaid