Provider Demographics
NPI:1467966556
Name:HAND OF GRACE LLC
Entity Type:Organization
Organization Name:HAND OF GRACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARQUISE
Authorized Official - Middle Name:MENGUE
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-762-1052
Mailing Address - Street 1:1652 DARLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-1319
Mailing Address - Country:US
Mailing Address - Phone:443-762-1052
Mailing Address - Fax:
Practice Address - Street 1:1652 DARLEY AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1319
Practice Address - Country:US
Practice Address - Phone:443-762-1052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRS4097251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health