Provider Demographics
NPI:1437325578
Name:GRACE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:GRACE MEDICAL CENTER, INC.
Other - Org Name:GRACE MEDICAL CENTER - OUTPATIENT RENAL DIALYSIS CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-924-1856
Mailing Address - Street 1:2000 W BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-1558
Mailing Address - Country:US
Mailing Address - Phone:410-362-3000
Mailing Address - Fax:
Practice Address - Street 1:2000 W BALTIMORE ST FL 2NDD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-1558
Practice Address - Country:US
Practice Address - Phone:410-362-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD753761100Medicaid
MD212309Medicare Oscar/Certification