Provider Demographics
NPI:1417726837
Name:STEP UP FROM GRACE, LLC
Entity Type:Organization
Organization Name:STEP UP FROM GRACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-831-1577
Mailing Address - Street 1:514 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-3587
Mailing Address - Country:US
Mailing Address - Phone:410-831-1577
Mailing Address - Fax:
Practice Address - Street 1:1304 S DIVISION ST STE 1
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6999
Practice Address - Country:US
Practice Address - Phone:410-831-1577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder